Summary

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• Alimta (pemetrexed) is indicated in combination with pembrolizumab and platinum chemotherapy for the initial treatment of patients with metastatic non-squamous non-small cell lung cancer (NSCLC) with no EGFR or ALK genomic tumor aberrations. It is also used in combination with cisplatin for the initial treatment of patients with locally advanced or metastatic non-squamous NSCLC; as a single agent for the maintenance treatment of patients with locally advanced or metastatic non-squamous NSCLC whose disease has not progressed after four cycles of platinum-based first-line chemotherapy; and as a single agent for the treatment of patients with recurrent, metastatic non-squamous NSCLC after prior chemotherapy.
• This summary is based on the review of 12 systematic review(s)/meta-analysis(es). ^[1-12]
• Lorlatinib demonstrated superior progression-free survival (PFS) in ALK-positive NSCLC when compared to pemetrexed-based chemotherapy (HR, 0.17; 95% CI, 0.12-0.23).
• Pemetrexed combined with EGFR-TKI provided a significant overall survival (OS) benefit in NSCLC compared to TKI alone (HR = 0.63, 95% CI, 0.43-0.86).
• The combination of pembrolizumab, pemetrexed, and platinum significantly improved PFS in NSCLC compared to placebo, pemetrexed, and platinum (HR: 0.53; 95% CI: 0.42-0.68).
• In patients with ALK-positive NSCLC and brain metastases, Lorlatinib showed the best PFS benefit compared to other treatments.
• Lorlatinib demonstrated a poorer safety profile compared to pemetrexed-based chemotherapy, with a higher incidence of grade 3 or higher adverse events.
• The combination of pemetrexed with EGFR-TKI or pembrolizumab generally increased the incidence of grade 3 or higher adverse events, with particular toxicity concerns for gefitinib plus pemetrexed.
• Pemetrexed-platinum with bevacizumab showed higher rates of anemia and thrombocytopenia but lower rates of neutropenia, febrile neutropenia, and sensory neuropathy compared to paclitaxel-carboplatin with bevacizumab.