培美曲塞治疗全身化疗和吉非替尼治疗失败的肺腺癌32例临床观察

Clinical Investigation of Efficacy of Pemetrexed in 32 Patients with Pulmonary Adenocarcinoma after Failure to Chemotherapy and Gefitinib

背景与目的吉非替尼二线或三线治疗晚期非小细胞肺癌的维持时间尚不理想。本研究旨在观察培美曲塞对全身化疗和吉非替尼治疗失败后肺腺癌患者的疗效和毒副反应。方法 32例经过全身化疗和吉非替尼治疗后肿瘤进展的晚期肺腺癌患者,培美曲塞500mg/m2静脉滴注,第1天,每21天为1周期,并口服地塞米松、叶酸和肌肉注射维生素B12以减轻毒副反应。根据实体瘤疗效评价标准对客观缓解率进行评价,毒副反应按美国国立癌症研究所制定的通用药物毒性评价标准(第3版)进行评价。结果 32例患者中,部分缓解4例(12.5%),疾病稳定11例(34.4%),疾病进展17例(53.1%),中位无进展生存期为2.7个月,中位生存期为11.0个月,1年生存率为37.5%,最常见的毒副反应为骨髓抑制,多为I、II级。非血液学毒性反应较轻,病人耐受性良好。结论对于晚期肺腺癌患者,在化疗和吉非替尼治疗失败后,给予培美曲塞解救治疗有临床获益。

Background and objective The relapse-free time of gefitinib as the second or third line therapy in patients with advanced non-small cell lung cancer （NSCLC） was not satisfactory.The aim of this study is to evaluate the efficacy and toxicity of pemetrexed in patients with pulmonary adenocarcinoma after failure to chemotherapy and gefitinib.Methods A total of 32 relapsed patients with pulmonary adenocarcinoma after failure to chemotherapy and gefitinib received pemetrexed 500 mg/m2 by the intravenous administration on the first day,with 21 days as a cycle.Dexamethasone,folic acid and vitamin B12 were applied to relieve the drug toxicity.The objective response rate was estimated by Response Evaluation Criteria in Solid Tumors （RECIST） and the toxicity was estimated by National Cancer Institute Common Toxicity Criteria （version 3.0）.Results For a total of 32 patients,4 patients reached partial response （PR）,constituting a total of 12.5%;11 patients reached stable disease （SD）,constituting a total of 34.4%;17 patients reached progressive disease （PD）,constituting a total of 53.1%.The median progression free survival （PFS） was 2.7 months.The median overall survival （OS） was 11.0 months.One-year survival rate was 37.5%.The most common adverse events （AEs） were myelosuppression with grade I and grade II toxicity.Other adverse events were tolerated.Conclusion Pemetrexed was clinically beneficial for the patients with pulmonary adenocarcinoma after the failure of chemotherapy and gefitinib.