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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

ISSN:2249-5347<br />

IJSID<br />

International Journal <strong>of</strong> Science Innovations and Discoveries<br />

An International peer<br />

Review Journal <strong>for</strong> Science<br />

Research Article<br />

Available online through www.ijsidonline.<strong>info</strong><br />

RP-HPLC METHOD FOR THE ESTIMATION OF PEMETREXED ASSAY IN<br />

FORMULATIONS.<br />

L. Maheswara Reddy 1* , P. Raveendra Reddy 1 , L. Bhaskar Reddy and K. Janardhan Reddy 2<br />

1Department <strong>of</strong> Chemistry, Sri Krishnadevaraya University, Anantapur-515 055, Andhra Pradesh, India.<br />

2Department <strong>of</strong> Nanomaterial Chemistry, Donguguk University, 707 Seokjang-Dong, Gyeongju-780 714, Republic <strong>of</strong> Korea<br />

Received: 20.07.2011<br />

Modified: 29.07.2011<br />

Published: 12.08.2011<br />

Keywords: Pemetrexed,<br />

RP-HPLC<br />

and validation<br />

*Corresponding Author<br />

Address:<br />

Name: L.Maheswara Redddy<br />

Place: Hyderabad<br />

E-mail: mahi_reddy67@yahoo.com<br />

ABSTRACT<br />

Formulations<br />

A simple RP-HPLC <strong>method</strong> was developed and validatied <strong>for</strong><br />

<strong>method</strong> development<br />

<strong>the</strong> determination <strong>of</strong> Pemetrexed in pharmaceutical dosage<br />

<strong>for</strong>ms. Mobile phase composed <strong>of</strong> buffer (1.0ml <strong>of</strong><br />

orthophosporic acid into 1000 ml <strong>of</strong> Milli-Q water) and<br />

acetonitrile in <strong>the</strong> ratio <strong>of</strong> 85: 15 v/v, Inertsil C18 (150×4.6<br />

mm, 5µm) HPLC column and absorbance was measured at<br />

230nm. Column oven temperature maintained at 25 o C,<br />

injection volume was 5µL and 12min runtime was seletected<br />

<strong>for</strong> analysis. Method validation was per<strong>for</strong>med as per ICH<br />

guidelines, with respect to linearity, accuracy, precision,<br />

ruggedness and robustness. Linearity was evaluated and<br />

found to be linear in <strong>the</strong> range <strong>of</strong> 117ppm to 780ppm,<br />

correlation coefficient is 0.999. Recovery studies also<br />

checked and found to be within <strong>the</strong> limit. This <strong>method</strong> has<br />

applicable <strong>for</strong> regular analysis.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

INTRODUCTION<br />

Pemetrexed (1-10) is a chemo<strong>the</strong>rapeutic drug, used <strong>for</strong> <strong>the</strong> treatment <strong>of</strong> malignant pleural<br />

meso<strong>the</strong>lioma (MPM) in combination with cisplatin, a platinum-containing chemo<strong>the</strong>rapeutic use. It is<br />

used as a single agent or in combination with o<strong>the</strong>r chemo<strong>the</strong>rapeutic agents <strong>for</strong> <strong>the</strong> treatment <strong>of</strong> o<strong>the</strong>r<br />

types <strong>of</strong> cancer such as breast cancer, bladder cancer, colorectal cacinoma and cervical cancer. The<br />

dosage <strong>of</strong> <strong>pemetrexed</strong> is depending on a number <strong>of</strong> factors, including body height, weight and response to<br />

this medication. Pemetrexed available in injection dosage <strong>for</strong>m. It is injected slowly (infused) into a vein.<br />

Each infusion takes about 10 minutes. In most cases, you will receive one infusion every 21 days. The<br />

serious side effects are pale skin, easy bruising or bleeding, unusual weakness, fever, chills, body aches,<br />

chest pain, trouble breathing and swelling. Pemetrexed is a suitable third-line treatment option with<br />

good efficacy and tolerable toxicity pr<strong>of</strong>ile <strong>for</strong> Non-small Cell Lung Cancer (NSCLC). Figure-1 represents<br />

<strong>the</strong> chemical structure <strong>of</strong> Pemetrexed.<br />

Figure-1: Chemical structure <strong>of</strong> Pemetrexed<br />

Pemetrexed and its dosage froms have reported <strong>method</strong>s. In <strong>the</strong> present study developed <strong>the</strong><br />

simple, less runtime and accurate RP-HPLC <strong>method</strong> <strong>for</strong> <strong>the</strong> quantification <strong>of</strong> <strong>pemetrexed</strong> in bulk and all<br />

type <strong>of</strong> dosage <strong>for</strong>ms.<br />

MATERIALS AND METHODS<br />

Chemicals and Reagents<br />

HPLC grade acetonitrile and water were purchased from Merck, AR grade orthophospharic acid,<br />

Sodium chloride, Hydrochloric acid, Sodium hydroxide, Hydrogen peroxide and o<strong>the</strong>r reagents were<br />

procured from S.D. Fine chemicals Ltd. High pure standards and all market samples were used <strong>for</strong> this<br />

study. GL Science makes Inertsil column was used <strong>for</strong> this product.<br />

Instrumentation: Waters make 2489 model LC system was used <strong>for</strong> chromatographic analysis and<br />

equipment operated with Empower s<strong>of</strong>tware.<br />

Chromatographic conditions:<br />

Buffer<br />

: Transferred 1.0mL <strong>of</strong> orthophosporic acid into 1000 ml <strong>of</strong> Milli-Q water,<br />

mixed and degassed.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

Mobile Phase : Mixed <strong>the</strong> buffer and Acetonitrile in <strong>the</strong> ratio 85:15v/v and degassed.<br />

Diluent<br />

Column<br />

Flow rate<br />

Wavelength<br />

: 0.9% Sodium chloride solution<br />

: Inertsil 150x4.6mm 5µm.<br />

: 1.5 mL per minute<br />

: 230nm<br />

Inj. Volume : 5µL<br />

Run time<br />

: 12minutes<br />

Standard Preparation (500ppm): Weigh about 50 mg <strong>of</strong> Pemetrexed di-sodium WS in to 100ml<br />

volumetric flask, add 75ml diluent , dissolve and dilute to volume with same and mix well.<br />

Sample Preparation: Prepared <strong>the</strong> all dosage <strong>for</strong>ms equivalent to 500ppm <strong>of</strong> <strong>pemetrexed</strong> with diluent.<br />

System suitability: The USP tailing factor <strong>for</strong> standard peak should be not more than 2.0; <strong>the</strong> % relative<br />

standard deviation should be not more than 2.0% and USP <strong>the</strong>oretical plates <strong>for</strong> standard solution should<br />

be not less than 2000.<br />

Calculation:<br />

% <strong>of</strong> Assay: Area <strong>of</strong> test sample x Concentration <strong>of</strong> Std x Potency <strong>of</strong> Std.<br />

Area <strong>of</strong> Std. sample x Concentration <strong>of</strong> sample<br />

Optimization <strong>of</strong> Chromatographic Conditions:<br />

RESULTS AND DISCUSSION<br />

Chromatographic conditions were optimised by using various mobile phases containing<br />

phosphate, sulphate, acetate buffers at pH 2-6 and various organic solvents such as acetonitile, methanol<br />

and ethanol and different make HPLC columns. Finally, optimised chromatographic conditions with<br />

orthophosphate buffer, acetonitrile as solvent and Inertsil C18 column. Figure-2 and 3 represent <strong>the</strong><br />

diluent and standard solution chromatograms.<br />

Figure-2: Blank chromatogram<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

System Suitability:<br />

Figure-3: Standard solution<br />

System suitability parameters were evaluated from five replicate standard injections and found to<br />

be within <strong>the</strong> limit. Calculated <strong>the</strong> % RSD (0.1%) from five replicate injections <strong>for</strong> <strong>pemetrexed</strong> peak area<br />

and was found to be within <strong>the</strong> limit (The acceptable % <strong>of</strong> relative standard deviation <strong>of</strong> peak areas <strong>of</strong><br />

<strong>pemetrexed</strong> should be not more than 2%), tailing factor <strong>of</strong> <strong>the</strong> active peak in standard solution is 1.1.<br />

(Acceptance limit is not more than 2.0) and <strong>the</strong> area ratio between two peaks is within <strong>the</strong> limit. Table-1<br />

represents <strong>the</strong> system suitability results.<br />

Specificity:<br />

Table-1: System suitability results<br />

System suitability Results<br />

Std. No<br />

Pemetrexed<br />

01 5857358<br />

02 5880172<br />

03 5868972<br />

04 5869287<br />

05 5870451<br />

Average 5869248<br />

%RSD 0.1%<br />

Specificity <strong>of</strong> <strong>the</strong> <strong>method</strong> was checked by conducting placebo interference and stress study with<br />

acid (0.1N HCl), base (0.1N NaOH), hydrogen peroxide (1% hydrogen peroxide <strong>for</strong> 15 min), and <strong>the</strong>rmal<br />

water <strong>for</strong> 15 min, humidity, UV light and sun light degradation at 60 o C. Placebo and degradation products<br />

have no interference with <strong>the</strong> <strong>pemetrexed</strong> peak. Peak purity results indicate that <strong>the</strong> <strong>method</strong> was more<br />

specific and accurate. Peak purity results were tabulated in table-2. Figure-4 to 12 represents <strong>the</strong> peak<br />

purity flat in all stress study conditions.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

0 .3 6<br />

0 .3 4<br />

0 .3 2<br />

0 .3 0<br />

0 .2 8<br />

0 .2 6<br />

0 .2 4<br />

0 .2 2<br />

P u rit y<br />

N o is e + S o lve n t ( 1 . 0 0 )<br />

Pemtrexed - 5.367<br />

9 0 .0 0<br />

8 0 .0 0<br />

7 0 .0 0<br />

6 0 .0 0<br />

AU<br />

0 .2 0<br />

0 .1 8<br />

0 .1 6<br />

0 .1 4<br />

5 0 .0 0<br />

4 0 .0 0<br />

Degrees<br />

0 .1 2<br />

0 .1 0<br />

0 .0 8<br />

0 .0 6<br />

0 .0 4<br />

0 .0 2<br />

0 .0 0<br />

- 0 .0 2<br />

3 0 .0 0<br />

2 0 .0 0<br />

1 0 .0 0<br />

0 . 0 0<br />

5 . 0 0 5 .1 0 5 .2 0 5 . 3 0 5 . 4 0 5 .5 0 5 . 6 0 5 . 7 0 5 .8 0 5 .9 0 6 . 0 0 6 .1 0 6 .2 0<br />

M in u te s<br />

Figure-4: Purity plot <strong>of</strong> peroxide stressed sample<br />

Table-2: Stress study results<br />

Sr No Name <strong>of</strong> Sample Purity Angle Purity Threshold Peak purity<br />

01 Peroxide Stress (1%) 0.179 1.216 Pass<br />

02 Acid Stress (0.1N/1hrs) 0.143 1.178 Pass<br />

03 UV Stress 0.189 1.247 Pass<br />

04 Humidity stress 0.180 1.228 Pass<br />

05 Sunlight Stress 0.193 1.235 Pass<br />

06 Thermal Stress 0.186 1.235 Pass<br />

07 Base Stress (0.1N/ 2hrs) 2.005 3.528 Pass<br />

08 Water Stress 0.151 1.180 Pass<br />

09 Unstressed 0.160 1.209 Pass<br />

0.024<br />

0.022<br />

0.020<br />

0.018<br />

0.016<br />

0.014<br />

P urity<br />

Nois e+ S olvent (1.00)<br />

Pemtrexed - 5.376<br />

90.00<br />

80.00<br />

70.00<br />

60.00<br />

AU<br />

0.012<br />

0.010<br />

50.00<br />

40.00<br />

Degrees<br />

0.008<br />

0.006<br />

0.004<br />

0.002<br />

30.00<br />

20.00<br />

10.00<br />

0.000<br />

0.00<br />

5.05 5.10 5.15 5.20 5.25 5.30 5.35 5.40 5.45 5.50 5.55 5.60 5.65 5.70 5.75 5.80 5.85<br />

Minutes<br />

Figure-5: Purity plot <strong>of</strong> Acid stressed sample.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

0 .4 0<br />

0 .3 5<br />

0 .3 0<br />

0 .2 5<br />

P u rit y<br />

N o is e + S o lve n t (1 . 0 0 )<br />

Pemtrexed - 5.381<br />

9 0 .0 0<br />

8 0 .0 0<br />

7 0 .0 0<br />

6 0 .0 0<br />

AU<br />

0 .2 0<br />

0 .1 5<br />

5 0 .0 0<br />

4 0 .0 0<br />

Degrees<br />

0 .1 0<br />

3 0 .0 0<br />

0 .0 5<br />

2 0 .0 0<br />

1 0 .0 0<br />

0 .0 0<br />

0 .0 0<br />

5 .0 0 5 .1 0 5 .2 0 5 .3 0 5 .4 0 5 .5 0 5 .6 0 5 .7 0 5 .8 0 5 .9 0 6 .0 0 6 .1 0 6 .2 0<br />

M in u te s<br />

Figure-6: Purity plot <strong>of</strong> UV stressed sample.<br />

0 .40<br />

0 .35<br />

0 .30<br />

0 .25<br />

P u rity<br />

N o is e+ S o lve n t (1 .0 0 )<br />

Pemtrexed - 5.371<br />

9 0.0 0<br />

8 0.0 0<br />

7 0.0 0<br />

6 0.0 0<br />

AU<br />

0 .20<br />

0 .15<br />

5 0.0 0<br />

4 0.0 0<br />

Degrees<br />

0 .10<br />

0 .05<br />

0 .00<br />

3 0.0 0<br />

2 0.0 0<br />

1 0.0 0<br />

0 .0 0<br />

5.0 0 5.1 0 5 .2 0 5 .3 0 5 .4 0 5 .5 0 5 .6 0 5 .7 0 5.8 0 5 .9 0 6 .0 0 6 .10 6 .20<br />

Min u te s<br />

Figure-7: Purity plot <strong>of</strong> Humidity stressed sample.<br />

0 . 4 0<br />

0 . 3 5<br />

0 . 3 0<br />

0 . 2 5<br />

P u rit y<br />

N o is e + S o lve n t (1 . 0 0 )<br />

Pemtrexed - 5.382<br />

9 0 . 0 0<br />

8 0 . 0 0<br />

7 0 . 0 0<br />

6 0 . 0 0<br />

AU<br />

0 . 2 0<br />

0 . 1 5<br />

5 0 . 0 0<br />

4 0 . 0 0<br />

Degrees<br />

0 . 1 0<br />

0 . 0 5<br />

3 0 . 0 0<br />

2 0 . 0 0<br />

1 0 . 0 0<br />

0 . 0 0<br />

0 .0 0<br />

5 .0 0 5 .1 0 5 .2 0 5 . 3 0 5 . 4 0 5 . 5 0 5 . 6 0 5 . 7 0 5 .8 0 5 .9 0 6 .0 0 6 .1 0<br />

M in u te s<br />

Figure-8: Purity plot <strong>of</strong> Sunlight stressed sample.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

0 .4 0<br />

0 .3 5<br />

0 .3 0<br />

0 .2 5<br />

P u rit y<br />

N o is e + S o lve n t (1 . 0 0 )<br />

Pemtrexed - 5.379<br />

9 0 .0 0<br />

8 0 .0 0<br />

7 0 .0 0<br />

6 0 .0 0<br />

AU<br />

0 .2 0<br />

0 .1 5<br />

5 0 .0 0<br />

4 0 .0 0<br />

Degrees<br />

0 .1 0<br />

3 0 .0 0<br />

0 .0 5<br />

2 0 .0 0<br />

1 0 .0 0<br />

0 .0 0<br />

0 .0 0<br />

4 .9 0 5 .0 0 5 .1 0 5 .2 0 5 .3 0 5 .4 0 5 .5 0 5 .6 0 5 .7 0 5 .8 0 5 .9 0 6 .0 0 6 .1 0<br />

M in u te s<br />

Figure-9: Purity plot <strong>of</strong> Thermal stressed sample.<br />

0.024<br />

0.022<br />

0.020<br />

0.018<br />

0.016<br />

0.014<br />

P urity<br />

Noise+Solvent (1.00)<br />

Pemtrexed - 5.376<br />

90.00<br />

80.00<br />

70.00<br />

60.00<br />

AU<br />

0.012<br />

0.010<br />

50.00<br />

40.00<br />

Degrees<br />

0.008<br />

0.006<br />

0.004<br />

0.002<br />

30.00<br />

20.00<br />

10.00<br />

0.000<br />

0.00<br />

5.05 5.10 5.15 5.20 5.25 5.30 5.35 5.40 5.45 5.50 5.55 5.60 5.65 5.70 5.75 5.80 5.85<br />

Minutes<br />

Figure-10: Purity plot <strong>of</strong> Base stressed sample.<br />

0 .4 0<br />

0 .3 5<br />

0 .3 0<br />

0 .2 5<br />

P u rit y<br />

N o is e + S o lve n t (1 . 0 0 )<br />

Pemtrexed - 5.367<br />

9 0 .0 0<br />

8 0 .0 0<br />

7 0 .0 0<br />

6 0 .0 0<br />

AU<br />

0 .2 0<br />

0 .1 5<br />

5 0 .0 0<br />

4 0 .0 0<br />

Degrees<br />

0 .1 0<br />

0 .0 5<br />

3 0 .0 0<br />

2 0 .0 0<br />

1 0 .0 0<br />

0 .0 0<br />

0 .0 0<br />

5 .0 0 5 .1 0 5 .2 0 5 .3 0 5 .4 0 5 .5 0 5 .6 0 5 .7 0 5 .8 0 5 .9 0 6 .0 0 6 .1 0<br />

M in u te s<br />

Figure-11: Purity plot <strong>of</strong> Water stressed sample.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

0 .3 5<br />

0 .3 0<br />

0 .2 5<br />

P u rit y<br />

N o is e + S o lve n t (1 . 0 0 )<br />

Pemtrexed - 5.359<br />

9 0 .0 0<br />

8 0 .0 0<br />

7 0 .0 0<br />

6 0 .0 0<br />

AU<br />

0 .2 0<br />

0 .1 5<br />

5 0 .0 0<br />

4 0 .0 0<br />

Degrees<br />

0 .1 0<br />

3 0 .0 0<br />

0 .0 5<br />

2 0 .0 0<br />

1 0 .0 0<br />

0 .0 0<br />

0 . 0 0<br />

5 . 0 0 5 . 1 0 5 .2 0 5 .3 0 5 . 4 0 5 . 5 0 5 . 6 0 5 .7 0 5 .8 0 5 . 9 0 6 .0 0 6 .1 0 6 .2 0<br />

M in u te s<br />

Precision:<br />

Figure12: Purity plot <strong>of</strong> unstressed sample.<br />

Precision <strong>of</strong> <strong>the</strong> test <strong>method</strong> was evaluated by analysing six test samples. Test solutions were<br />

prepared as per <strong>the</strong> proposed <strong>method</strong> and intermediate precision also evaluated by using different<br />

preparations, analyst and instruments. Precision and intermediate precision results were tabulated in<br />

table-3.<br />

Accuracy:<br />

Sample No.<br />

Table-3: Precision Results<br />

%ASSAY OF PEMETREXED<br />

ANALYST-1 ANALYST-2<br />

1 101.4 101.6<br />

2 101.2 100.7<br />

3 100.5 101.2<br />

4 100.9 102.2<br />

5 101.4 101.6<br />

6 101.4 100.8<br />

Average 101.1 101.3<br />

% RSD 0.4% 0.54%<br />

Accuracy <strong>of</strong> <strong>the</strong> <strong>method</strong> was determined by analysing with placebo and standard. Standard stock<br />

solution was spiked in to <strong>the</strong> placebo solution at different concentration levels. Results were found to be<br />

within in <strong>the</strong> limit (Between 97% and 103%) and tabulated in table-4.<br />

Table-4: Accuracy Results<br />

Sample no. Spike level ‘mg/mL’ added<br />

‘mg/mL’ found Mean %<br />

(recovered) recovery<br />

1 50% 0.250 0.253 101.20<br />

2 80% 0.400 0.397 99.25<br />

3 100% 0.500 0.508 101.60<br />

4 133% 0.666 0.668 100.30<br />

5 200% 1.000 0.989 98.90<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

8


Linearity:<br />

Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

The linearity <strong>of</strong> <strong>the</strong> <strong>method</strong> was checked from 117ppm to 780ppmand <strong>the</strong> results shown in table-<br />

5. The correlation coefficient, 0.999 was indicates <strong>the</strong> linearity <strong>of</strong> <strong>the</strong> test <strong>method</strong>.<br />

Ruggedness:<br />

Table-5: Linearity Results<br />

% Level Standard<br />

concentration(mg/<br />

ml)<br />

Pemetrexed<br />

Area<br />

24% 117 1404747<br />

60% 293 3512651<br />

80% 390 4683354<br />

100% 488 5853487<br />

120% 585 7036505<br />

160% 780 9408045<br />

Coefficient <strong>of</strong> correlation (r) 0.9999<br />

Slope (m) 12069<br />

Y-Intercept -20225<br />

Coefficient <strong>of</strong> Regression (r2) 1.0000<br />

System to system /Analyst to Analyst/column to Column variability study was conducted under<br />

similar conditions at different times <strong>for</strong> ruggedness <strong>of</strong> <strong>the</strong> <strong>method</strong>. A study to establish stability <strong>of</strong><br />

standard and test preparation on bench top was conducted over period <strong>of</strong> two days. Confirms <strong>the</strong><br />

standard and test solution were stable during this assay <strong>of</strong> 2 days period. Comparison <strong>of</strong> both <strong>the</strong> results<br />

obtained on two different HPLC systems, different column and different analysts shows that <strong>the</strong> related<br />

assay <strong>method</strong> is rugged <strong>for</strong> system to system /analyst to analyst/column to column variability.<br />

Robustness:<br />

The experimental conditions were pu<strong>rp</strong>osely altered <strong>for</strong> <strong>the</strong> determination <strong>of</strong> robustness <strong>of</strong><br />

<strong>method</strong> such as variation in organic phase composition in mobile phase, flow rate, column temperature<br />

but no significant change in assay value was observed.<br />

CONCLUSION<br />

The developed RP-HPLC <strong>method</strong> <strong>for</strong> <strong>the</strong> determination <strong>of</strong> <strong>pemetrexed</strong> is more precise, accurate<br />

and selective with good system suitability, ruggedness and robustness by satisfactory results. This<br />

<strong>method</strong> can be successfully used <strong>for</strong> determination <strong>of</strong> <strong>pemetrexed</strong> in bulk and <strong>for</strong>mulation samples<br />

REFERENCES<br />

1. Schiller JH, Harrington D and CP Belani, Comparison <strong>of</strong> four chemo<strong>the</strong>rapy regimens <strong>for</strong> advanced<br />

non-small-cell lung cancer, N Engl J Med, 2002, 346, 92-98.<br />

International Journal <strong>of</strong> Science Innovations and Discoveries VOL1, Issue 1, July-August 2011<br />

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Maheswara Reddy et al., IJSID 2011, 1 (1), 1-10<br />

2. Scagliotti GV, De Marinis F and Rinaldi M, Phase III randomized trial comparing three platinum-based<br />

doublets in advanced non-small-cell lung cancer, Journal <strong>of</strong> Clinical Oncology, 2002, 20, 4285-4291.<br />

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