Pemetrexed in second line of non-small cell lung cancer

Non small cell lung cancer (NSCLC), which is the leading cause of cancer mortality, is accounts for 85% of all cases of lung cancer. The majority of NSCLC patients present with advanced, unresectable disease. In advanced disease; chemotherapy with platinun (cisplatin or carboplatin) in combination with a third-generation cytotoxic drug (gemcitabine, vinorelbine, paclitaxel or docetaxel) can provide a modest improvement in survival with quality of life. Response rates of 20%-40% can be expected with a median survival of 8-10 months and a 1 year survival rate of 30% - 40%. Pemetrexed, a multitargeted antifolate agent, has shown clear activity in mesothelioma and NSCLC. In a phase III trial, second line treatment with pemetrexed demonstrated overall survival comparable to docetaxel with a more manageable toxicity profile. Single agent pemetrexed have shown well tolerate in elderly patients, in combination with radiotherapy where we can use full dose pemetrexed. In second line, in non-squamous NSCLC pemetrexed administrated with folic acid and vitamin B12, has a significant superior survival compared with docetaxel (9.3 vs 8.0 months).