Adjuvant Pemetrexed/Cisplatin vs Vinorelbine/Cisplatin in Stage II–IIIA Nonsquamous NSCLC

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In a 5-year analysis of the Japanese phase III JIPANG trial reported in the Journal of Clinical Oncology, Kenmotsu et al found no significant differences in overall or recurrence-free survival with adjuvant pemetrexed/cisplatin vs vinorelbine/cisplatin in patients with stage II–IIIA nonsquamous non–small cell lung cancer (NSCLC).

Study Details

In the open-label multicenter study, 783 eligible patients were randomly assigned between March 2012 and August 2016 to receive pemetrexed/cisplatin (n = 389) or vinorelbine/cisplatin (n = 384). The initial report from the study showed no significant improvement in recurrence-free survival (primary endpoint) with pemetrexed/cisplatin compared with vinorelbine/cisplatin.

Key Findings

Updated median recurrence-free survival was 43.4 months with pemetrexed/cisplatin vs 37.5 months with vinorelbine/cisplatin (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.79–1.14). Rates at 3 and 5 years were 51.6% vs 51.0% and 44.9% vs 42.6%, respectively.

At a median follow-up of 77.3 months, median overall survival was not reached in both the pemetrexed/cisplatin and vinorelbine/cisplatin groups (HR = 1.03, 95% CI = 0.80–1.32). Rates at 3 and 5 years were 87.0% vs 84.1% and 75.0% vs 75.6%, respectively. Among 192 patients (95 vs 97) with EGFR-mutant disease, 5-year overall survival was 86.1% with vinorelbine/cisplatin vs 70.9% with pemetrexed/cisplatin. 

The investigators concluded: “This long-term follow-up analysis showed that pemetrexed/cisplatin had similar efficacy to vinorelbine/cisplatin in both recurrence-free survival and overall survival for this population, with one of the longest overall survival data compared with the historical data.”

Hirotsugu Kenmotsu, MD, PhD, of the Division of Thoracic Oncology, Shizuoka Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

Disclosure: The study was funded by the Japan Agency for Medical Research and Development and National Cancer Center. For full disclosures of the study authors, visit

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