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Cagney DN , Martin AM , Catalano PJ , Reitman ZJ , Mezochow GA , Lee EQ , Wen PY , Weiss SE , Brown PD , Ahluwalia MS , Arvold ND , Tanguturi SK , Haas-Kogan DA , Alexander BM , Redig AJ , Aizer AA
Impact of pemetrexed on intracranial disease control and radiation necrosis in patients with brain metastases from non-small cell lung cancer receiving stereotactic radiation
Radiother Oncol. 2018 Mar;126(3) :511-518
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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-naive, 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.
1879-0887 Cagney, Daniel N Martin, Allison M Catalano, Paul J Reitman, Zachary J Mezochow, Gabrielle A Lee, Eudocia Q Wen, Patrick Y Weiss, Stephanie E Brown, Paul D Ahluwalia, Manmeet S Arvold, Nils D Tanguturi, Shyam K Haas-Kogan, Daphne A Alexander, Brian M Redig, Amanda J Aizer, Ayal A Journal Article Ireland Radiother Oncol. 2018 Feb 2. pii: S0167-8140(18)30022-7. doi: 10.1016/j.radonc.2018.01.005.