Impact of pemetrexed on intracranial disease control and radiation necrosis in patients with brain metastases from non-small cell lung cancer receiving stereotactic radiation

Daniel N. Cagney, Allison M. Martin, Paul J. Catalano, Zachary J. Reitman, Gabrielle A. Mezochow, Eudocia Q. Lee, Patrick Y. Wen, Stephanie E. Weiss, Paul D. Brown, Manmeet S. Ahluwalia, Nils D. Arvold, Shyam K. Tanguturi, Daphne A. Haas-Kogan, Brian M. Alexander, Amanda J. Redig, Ayal A. Aizer

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: Pemetrexed is a folate antimetabolite used in the management of advanced adenocarcinoma of the lung. We sought to assess the impact of pemetrexed on intracranial disease control and radiation-related toxicity among patients with adenocarcinoma of the lung who received stereotactic radiation for brain metastases. Materials/Methods: We identified 149 patients with adenocarcinoma of the lung and newly diagnosed brain metastases without a targetable mutation receiving stereotactic radiation. Kaplan–Meier plots and Cox regression were employed to assess whether use of pemetrexed was associated with intracranial disease control and radiation necrosis. Results: Among the entire cohort, 105 patients received pemetrexed while 44 did not. Among patients who were chemotherapy-naïve, use of pemetrexed (n = 43) versus alternative regimens after stereotactic radiation (n = 24) was associated with a reduced likelihood of developing new brain metastases (HR 0.42, 95% CI 0.22–0.79, p = 0.006) and a reduced need for salvage brain-directed radiation therapy (HR 0.36, 95% CI 0.18–0.73, p = 0.005). Pemetrexed use was associated with increased radiographic necrosis. (HR 2.70, 95% CI 1.09–6.70, p = 0.03). Conclusions: Patients receiving pemetrexed after brain-directed stereotactic radiation appear to benefit from improved intracranial disease control at the possible expense of radiation-related radiographic necrosis. Whether symptomatic radiation injury occurs more frequently in patients receiving pemetrexed requires further study.

Original languageEnglish
Pages (from-to)511-518
Number of pages8
JournalRadiotherapy and Oncology
Volume126
Issue number3
DOIs
StatePublished - Mar 2018

Keywords

  • Adenocarcinoma of Lung
  • Adenocarcinoma/drug therapy
  • Aged
  • Antineoplastic Agents/administration & dosage
  • Brain Neoplasms/drug therapy
  • Brain/pathology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms/drug therapy
  • Male
  • Middle Aged
  • Necrosis
  • Pemetrexed/administration & dosage
  • Radiation Injuries/etiology
  • Radiosurgery/adverse effects
  • Retrospective Studies

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