Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Phase III Trial of Single-Agent Pemetrexed (Alimta®) Versus the Combination of Carboplatin and Pemetrexed in Patients With Advanced Non-small-cell Lung Cancer and Performance Status of 2
Brief Summary: Optimal management of patients with advanced NSCLC and with PS 2 remains controversial and underrepresented in clinical trials, typically accounting for 5 to 10% of enrolled patients. Patient PS 2 proportion in population-based studies is considerably higher than that included in clinical trials. Management of patients with PS of 2 in clinical practice is empirical and inconsistent. Patients have median overall survival of 3 to 5 months in randomized trials, and treatment options include best supportive care, single-agent and combination chemotherapy. Retrospective studies have suggested that patients PS 2 may benefit from first-line chemotherapy in terms of symptom improvement and overall survival. In many of these studies, single-agent chemotherapy was compared with best supportive care alone. Data on the role of cisplatin-based combinations for patients with PS 2 is more scant, with one study questioning its benefit, and another interrupting accrual because of undue toxicity. With regards to carboplatin, the Cancer and Leukemia Group B (CALGB) study 9730 compared paclitaxel plus carboplatin versus paclitaxel alone in a subgroup of 107 patients with PS 2; the median overall survival was significantly longer in group treated with combination chemotherapy (4.7 versus 2.4 months). Combination chemotherapy with carboplatin and paclitaxel also produced a statistically significantly higher incidence of severe hematological and non-hematological toxicities. On the basis of aforementioned results, a recent European panel stated that carboplatin-based or low-dose cisplatin-based doublets might represent alternative options to single-agent chemoterapy in patients PS 2. Outside clinical trials, single-agent chemotherapy with a 3rd generation agent remains valid option for patients PS2. Results demonstrate that pemetrexed is an agent with established single-agent activity in NSCLC, and suggest it is a potential candidate for combinations with platinum and other agents currently utilized for patients with advanced NSCLC. Favorable toxicity profile of pemetrexed suggests that this agent is an ideal candidate for single agent testing and in combination among patients with PS 2. Substantial doubt remains in the comparative benefit from monotherapy versus combination. Starting dose and schedule of pemetrexed were set for this study based on its current labeling in the 2nd line treatment of metastatic NSCLC and 1st line treatment of malignant pleural mesothelioma.


Options:
A: Intervention Type: DRUG; Name: Gemcitabine; Assigned to Arm(s): N/A | Intervention Type: DRUG; Name: Carboplatin; Assigned to Arm(s): N/A
B: Arm Label: Arm B; Type: EXPERIMENTAL; Interventions: Drug: gemcitabine, Drug: cisplatin | Arm Label: Arm A; Type: ACTIVE_COMPARATOR; Interventions: Drug: gemcitabine | Intervention Type: DRUG; Name: gemcitabine; Assigned to Arm(s): Arm A, Arm B | Intervention Type: DRUG; Name: cisplatin; Assigned to Arm(s): Arm B
C: Arm Label: Arm A: Nivolumab; Type: EXPERIMENTAL; Interventions: Biological: Nivolumab | Arm Label: Arm B: Docetaxel; Type: EXPERIMENTAL; Interventions: Drug: Docetaxel | Intervention Type: BIOLOGICAL; Name: Nivolumab; Assigned to Arm(s): Arm A: Nivolumab | Intervention Type: DRUG; Name: Docetaxel; Assigned to Arm(s): Arm B: Docetaxel
D: Arm Label: Arm B; Type: EXPERIMENTAL; Interventions: Drug: Pemetrexed, Drug: Carboplatin | Arm Label: Arm A:; Type: ACTIVE_COMPARATOR; Interventions: Drug: Pemetrexed | Intervention Type: DRUG; Name: Pemetrexed; Assigned to Arm(s): Arm A:, Arm B | Intervention Type: DRUG; Name: Carboplatin; Assigned to Arm(s): Arm B

Answer: D