Based on this trial, the U.S. FDA approved pemetrexed for second-line treatment of locally advanced or metastatic NSCLC [6]. In our study, 53 patients were enrolled. All patients had experienced platinum-based chemotherapy. Most of patients BTK inhibitor (>70%) had good clinical conditions (ECOG PS 0 or 1). The patients treated with pemetrexed plus platinum were supplemented with dexamethasone, folic acid and vitamin B12. The addition of folic acid and

vitamin B12 supplementation markedly reduced the toxicity profile of pemetrexed, as shown in a previous trial comparing pemetrexed administered with or without vitamins [30]. The median number of cycles received was 3. No patient achieved CR. Seven of the 53 patients (13.2%) showed PR. The ORR (13.2%) is higher than that of single pemetrexed (8.8%) reported by Hanna et al. The stable disease rate was 67.9% in this study, which was markedly higher than that of single pemetrexed (45.8%) in Hanna’s study. The DCR for pemetrexed plus cisplatin/carboplatin Epigenetics Compound Library research buy in this study and single pemetrexed in Hanna’s study were 81.1% and 54.6%, respectively, which also have a significant difference. The median progression-free survival was 6.0 months, which was two times longer than that of single pemetrexed (2.9 months) in Hanna’s study. The median OS time

was 10.0 months, which was also longer than that of single pemetrexed (8.3 months). The 1-year survival rate was 40.9%, which was higher than that of single pemetrexed (29.7%) in Hanna’s study. Compared with pemetrexed pheromone single agent chemotherapy, our study showed that locally advanced or metastatic NSCLC patients having experienced platinum-based chemotherapy might acquire a higher objective response rate, higher disease control rate, longer PFS, longer OS and higher 1-year survival rate from pemetrexed combined with platinum chemotherapy. The main reason we achieved better results should be due to the addition of platinum chemotherapy drugs. Of course, to exclude the impact of

race factor, we need further randomized controlled study. In our study, the most frequent hematological toxicities were neutropenia and thrombocytopenia (any grade) and the most frequent nonhematological toxicities were nausea/vomiting, fatigue, pyrexia and rash (any grade). The incidence of grade 3/4 neutropenia and thrombocytopenia was 9.5% and 7.6%, which was higher than that of pemetrexed single agent chemotherapy in Hanna’s randomized phase III study (5.3% and 1.9%). The incidence of grade 3/4 Anemia was 0, which was 4.2% in that randomized phase III study. The nonhematological toxicities were similar to single pemetrexed observed in Hanna’s study. Although the incidence of neutropenia and thrombocytopenia in pemetrexed plus cisplatin/carboplatin chemotherapy for previously treated locally advanced or metastatic NSCLC patients was slightly higher than pemetrexed single chemotherapy, the adverse events were tolerable. After treated, all patients acquired recovery from hematological toxicities.