Dr. Langer Discusses the JMEN Maintenance Pemetrexed Trial

Corey J. Langer, MD, Professor of Medicine, Director, Thoracic Oncology, Abramson Cancer Center, University of Pennsylvania, discusses the design and major criticisms of the JMEN phase III trial.

JMEN was a randomized trial looking at maintenance pemetrexed in advanced or metastatic (stage IIIB and IV) non-small-cell lung cancer. The trial examined patients that had been treated with platinum-based first-line chemotherapy and were stable or had not progressed. JMEN demonstrated a significant survival benefit and was heralded as a paradigm changing trial.

The largest criticism of the trial was the absence of a mandatory crossover from the control arm to intravenous pemetrexed. 67% of patients on the placebo arm received a second-line therapy, of this amount only 19% received pemetrexed, the remaining 81% received an EGFR TKI or docetaxel.

Langer believes that receiving second-line pemetrexed alone should have been built into the trial. If this had happened the trial could have prevented major criticism.