WCLC 2025 - Posters & ePosters-EP.10.01 Retrospective Study of Pemetrexed Monotherapy for Non-Small Cell Lung Cancer Patients by Renal Function

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This retrospective study by Koyanagi et al. evaluates the efficacy and safety of pemetrexed (PEM) monotherapy in non-small cell lung cancer (NSCLC) patients with varying renal function, focusing on those with creatinine clearance (Ccr) less than 45 mL/min—a group typically excluded from clinical trials. Conducted at NHO Iwakuni Clinical Center, Japan, the study analyzed 72 NSCLC patients receiving PEM monotherapy between 2010 and 2024, dividing them into two groups based on renal function: Ccr ≥45 mL/min (n=53) and Ccr <45 mL/min (n=19). After propensity score matching for age and body surface area, 19 patients per group remained for analysis.<br /><br />Results showed no significant difference in progression-free survival (PFS) or overall survival (OS) between the groups (median PFS: 146 vs. 104 days, p=0.542; median OS: 314 vs. 159 days, p=0.549). Treatment efficacy measured by response rates also did not differ significantly. Adverse events were comparable, though the renal impairment group exhibited a nonsignificant trend toward higher febrile neutropenia and thrombocytopenia rates. Importantly, PEM doses were not adjusted for renal function in this study; however, literature suggests dose adjustments may reduce hematological toxicity without compromising efficacy.<br /><br />The study supports the potential use of PEM monotherapy in NSCLC patients with moderate renal impairment when accompanied by careful monitoring and possible dose adjustment. Limitations include the small sample size of patients with impaired renal function and exclusion of those on platinum or immune checkpoint inhibitor combination therapies. The authors recommend further large-scale research to confirm these findings.<br /><br />In conclusion, PEM monotherapy demonstrated similar efficacy and safety profiles in NSCLC patients regardless of renal function status, suggesting it may be a viable salvage therapy option even in patients with reduced renal clearance.

Asset Subtitle

Taisaku Koyanagi

Meta Tag

Speaker Taisaku Koyanagi

Topic Metastatic Non-small Cell Lung Cancer – Cytotoxic Therapy

Keywords

pemetrexed monotherapy

non-small cell lung cancer

renal impairment

creatinine clearance

efficacy

safety

progression-free survival

overall survival

adverse events

dose adjustment