Author: Greatly.
Meningeal metastasis, as the "ultimate metastasis", has made the majority of lung cancer patients and their families change their faces. Fortunately, in recent years, intrathecal chemotherapy for meningeal metastasis has achieved gratifying clinical results, but because the clinical practice of intrathecal chemotherapy is still in the exploratory stage, doctors generally choose intrathecal chemotherapy drugs, dosage and frequency according to the actual situation of patients, and no expert consensus has been formed.
At the forum, it was jointly initiated by the team of Professor Lin Gen of Fujian Provincial Cancer Hospital for meningeal metastasis"Blessed is love."In the live broadcast of popular science, Professor Lin Gen also mentioned the relevant experimental research carried out by the team of Professor Xin Tao of the Department of Medical Oncology of the Second Affiliated Hospital of Harbin Medical University, and he is also looking forward to the follow-up results of this research.
Recently, the results of the phase trial of this study were announced. Happily, the study further confirms:For patients with meningeal metastases of lung cancer, intrathecal pemetrexed chemotherapy has shown remarkable efficacy and safety!
Pemetrexed 50 mg intrathecally
May be used as a recommended dose
In 2021, Prof. Xintao's team conducted a prospective, open-label, single-arm phase clinical trial to evaluate the efficacy and safety of intrathecal pemetrexed combined with dexamethasone** transEGFR-TKI** in patients with non-small cell lung cancer (LM-NSCLC) who failed to do so with meningeal metastases.
The results of the study showed:Pemetrexed 50 mg intrathecally is the recommended dose with few adverse events and a good response rate。Intrathecal pemetrexed** is an effective method for patients with EGFR-mutant LM-NSCLC who have failed EGFR-TKIS**.
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Intrathecal pemetrexed is one
Effective and safe** method
Subsequently, Professor Xintao's team expanded the scale of the trial to further explore the effectiveness and safety of this kind of **, and the main evaluation indices included:Overall survival（os）、Response rate and adverse events。Since the initiation of the study, the results have attracted much attention from both doctors and patients. Finally, the research data was released recentlyIt provides strong evidence for this strategy
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This large-scale, single-arm, phase 1 clinical trial included132 casesPatients with LM-NSCLC who have failed EGFR-TKI**. Among them, 68% of the patients were female, the median age was 52 years, 73% of the patients had brain parenchymal metastases, and 92% of the patients had symptoms of intracranial hypertension.
Of these patients, 73% had received a first-generation EGFR-TKI**, 22% had received a second-generation EGFR-TKI**, and 84% had received a third-generation EGFR-TKI**. Seventy-two percent of patients had received systemic chemotherapy, 11 percent had received intrathecal methotrexate and cytarabine**, and 39 percent had received radiation therapy to the brain.
During the trial, all patients received 2 intrathecal injections of pemetrexed in combination with dexamethasone (Monday and Friday) in week 1Induce**。Subsequently, 1 sheath injection is received every 3 weeksConsolidation**for a total of 4 weeks. Finally, receive 1 sheath per month as a givenMaintain**until disease progression or intolerance or adverse effects are observed.
During the 18 months of follow-up, patients received an average of 6 times of thecal pemetrexed, overallThe median survival (MOS) was 120 months
MOS in all patients
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According to Neuro-Oncology Response Assessment (RANO) criteria,After intrathecal injection of pemetrexed**, the patient's condition improved（os：4.0~51.0 months, median 0s: 150 monthsThe patient's condition was stable after menstruation（os：2.0~8.0 months, median OS: 40 months), 53% (7 132) of patients progressed after ** (OS: 1.).5~3.0 months, median OS: 30 months
In this phase II clinical data, it is worth noting that patients who respond to intrathecal pemetrexed** achieved median OS15 months, median OS was also achieved in stable patients4 monthsThis is a huge improvement over the previous era when the survival time of meningeal metastases of lung cancer was considered weekly
Security aspect, the main ** related adverse events include elevated aminotransferases, nausea, vomiting, bone marrow suppression, neurotoxicity, etc., and most of them are grade 1 2. The most common adverse reaction was bone marrow suppression (n=42), which improved after administration of the corresponding **.
This study further demonstrates that according to the RANO criteria, the ...Intrathecal pemetrexed is an effective and safe method for patients with EGFR-mutant NSCLC-LM, and should be used in clinical practice to bring better survival benefits to patients.
In summary, this study provides a new idea for patients with brain metastases with EGFR-mutant non-small cell lung cancer. As an effective and safe method, intrathecal pemetrexed is expected to bring better survival benefits to patients in clinical practice. However, further clinical research still needs to be explored to optimize the best strategy and provide patients with more personalized and accurate medical services.
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Effect of intrathecal pemetrexed**
Further is needed
The researchers said the study is the largest prospective study of NSCLC-LM** to date. However, this study also has certain limitations, such as the effect of intrathecal pemetrexed** in ALK+NSCLC and small cell lung cancer with meningeal metastases**.
If you have any doubts about intrathecal pemetrexed**, meningeal metastasis, etc., or want to consult ** plan, you canContinue to pay attention to the forum and the follow-up "Blessed by Love" activities of Professor Lingen's team, and experts will answer your questions during the live broadcast!
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