培美曲塞联合草酸铂一线治疗老年或功能状态差的晚期非小细胞肺癌患者的临床观察

Clinical effect of pemetrexed combined with oxaliplatin as front-line treatment of advanced non-small cell lung cancer in elderly patients or patients ineligible

为了评价培美曲塞联合草酸铂治疗老年(>70岁)或功能状态评分差的晚期非小细胞肺癌(NSCLC)患者的有效性和安全性,对32例NSCLC患者采用培美曲塞联合草酸铂方案治疗。培美曲塞500mg/m2,静脉滴入,d1,草酸铂100mg/m2,静脉滴入,d1,每3周为1个周期,共4～6个周期。每2个周期评估疗效,直至疾病进展;观察近期疗效和不良反应,进行随访。32例患者中CR0例,PR5例(15.6%),SD7例(21.9%),PD12例(62.5%),总有效率(CR+PR)为15.6%,疾病控制率(CR+PR+SD)为37.5%。全组病例随访2～20个月,随访率100%。总体平均生存期7.5个月(2～20个月),中位生存期8个月,1年生存率21.9%。主要毒副反应为血红蛋白减少、中性粒细胞减少、中性粒细胞减少性发热、血小板减少、脱发、恶心呕吐和腹泻等,发生率分别为25.0%、18.8%、15.6%、18.8%、25.0%、21.8%和18.8%。初步研究结果提示,培美曲塞联合草酸铂方案治疗或功能状态评分差的晚期NSCLC患者的疗效较好,不良反应较轻,患者的耐受性好。

The objective of this study was to observe the clinical efficacy and adverse effect of pemetrexed combined with oxaliplatin to treat elderly patients or patients（〉70 years old） ineligible with late-stage non-small cell lung cancer. Thirty two patients with advanced NSCLC were recruited in this study. They bad recurrence after receiving at least one or two regimens of platinum-based chemotherapy. Pemetrexed （500 mg/m^2 , iv drip, d1 ） combined with ox aliplatin（100 mg/m^2 , iv drip, d1 ） was given every 3 weeks as a cycle until disease progression with total 4-6 cycle. The clinical outcome and adverse reaction were observed every 2 weeks, and the patients were followed up. Among the 32 patients, 0 patients got complete response（0） ,S partial response （15.6%） , 7 stable disease （21.9%）, and 12 progressive disease （62.5 % ）. The total response rate （CR＋ PR） was 15.6 % and disease control rate including tumor response and stable disease was 37.5 %. All the patients were followed up for 1-22 months, three patients were still alive utill January 2009. The follow-up ratio was 100%. The average survival time was 7.5 months （2-20 months）, median overall survival period was 8 months and one year progression-free survival rate was 21.9%. The main toxici ties were hemoglobin reduction in n eutropenia（25.0 % ）, neutropenic fever（ 18.8 % ）, thrombocytopenia（ 15.6%）, alopecia（18.8%）, nausea（25.0%）, vomiting（21.8%） and diarrhea（18.8%）.The combination regimen of pemetrexed and oxaliplatin in the treatment of elderly patients or patients ineligible with late-stage non-small cell lung cancer has a good efficacy, slight adverse effect and could be well tolerated.