A Prospective Study of Shortened Vitamin Supplementation Prior to Cisplatin–Pemetrexed Therapy for Non-Small Cell Lung Cancer

摘要: Background. Prior supplementation with folic acid and vitamin B12 is required to reduce pemetrexed therapy toxicity; the recommended lead-in time at least 7 days. Onthebasisofpreviouspharmacokineticandclinicalstudies, we hypothesized that could be shortened 24 hours, enabling earlier commencement of standard chemotherapy;thus,weplannedthefirstprospectivetrialof this regimen. Methods. Patients advanced nonsquamous non-small cell lung cancer who had not previously received cytotoxic chemotherapy were enrolled. After measurement homocysteine concentrations, patients 1,000 m go f by intramuscular injection began taking 350–500 mg oral daily. Starting 24–48 hours after injection, intravenous 500mg/m 2 pemetrexedand75mg/m cisplatinfor4cyclesat3 weekly intervals.The primary endpoint was proportion developed neutropenia grade $3. Results.Thirty starting within 48 injection. No treatment-related deaths or 4 toxicity occurred. Neutropenia $3, other laboratory toxicities nonlaboratory toxicitiesgrade$3occurredin6.7%,13%,and13%ofpatients, respectively. The baseline concentrations higher in $ 3t oxicities than remainder cohort (mean values, 8.6 10.7 mmol/L, respectively).The response rate 43%. Conclusion.The well tolerated retained antitumor efficacy. Analysis confirmed efficacy short-term supplementation.The Oncologist 2014;19:1194–1199