Evaluation of Response and Toxicity of Pemetrexed-Carboplatin Versus Paclitaxel-Carboplatin as First-Line Treatment in Metastatic NSCLC

Non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancer approximately. The paclitaxel-carboplatin combination is the established standard regimen of choice in metastatic NSCLC. Pemetrexed, a folate antimetabolite is also effective against non-small cell lung cancer. To compare the response and toxicity of the Pemetrexed-Carboplatin regimen with Paclitaxel-Carboplatin in the treatment of metastatic NSCLC. This Quasi-experimental study was conducted from three centers of Dhaka city. 80 patients (40 patients on each arm) who met the inclusion criteria of the study were enrolled. Arm-A received 500mg/m<sup>2</sup> Pemetrexed (Day 1) plus Carboplatin; AUC=5 (Day 1) IV, in another arm, 175mg/m<sup>2</sup> Paclitaxel (Day 1) plus Carboplatin AUC=6; (Day 1) IV, dexamethasone was given 12 mg on night before and on the morning of chemotherapy of each cycle & repeated every 21 days for 6 cycles; were given. Both outcome and toxicities were evaluated. Regarding the tumor control, there was no statistically significant difference in both arms at the follow-up after 6 weeks of completion of chemotherapy [Partial response was seen in 24 (60.00%) patients in Arm-A and in 22 (55.00%) patients in Arm-B, <i>p</i>= 0.58]. Grade ≥3 neutropenia was seen in 09 (22.50%) patients of the Arm-A and 20 (50.00%) patients of Arm-B, p<0.005. Treatment-emergent alopecia was significantly higher in Arm-B [Arm-A, 07 (17.50%) vs Arm-B, 22 (55.00%) p<0.05]. Other non-hematological toxicity was also assessed in both arms and there was no significant difference in the frequency of adverse events. This study supports the fact that Pemetrexed-Carboplatin-based chemotherapy may be equally effective with less haematologic & non-haematologic toxicity than the Paclitaxel-Carboplatin-based chemotherapy regimen.