培美曲塞单药或联合铂类治疗晚期复治非小细胞肺癌54例临床观察

Pemetrexed Alone or Combination Regimen in Advanced Chemorecurrent Non-small Cell Lung Cancer ： Analysis of 54 Cases

背景与目的培美曲塞是一种多靶点抗叶酸化疗药，目前已成为晚期非小细胞肺癌二线治疗的标准药物。本研究回顾分析培美曲塞单药或联合铂类治疗晚期复治非小细胞肺癌的疗效及不良反应。方法对既往至少接受过1个标准含铂方案化疗的54例晚期非小细胞肺癌患者，分为单药治疗组2l例，联合铂类治疗组33例。单药治疗组给予培美曲塞单药治疗，培美曲塞500mg／m2，第1天。21天为1个周期；联合铂类治疗组给予培美曲塞联合顺铂或卡铂，培美曲塞500mg／m2，第1天，顺铂75mg／m2或卡铂AUC=5，第1天，21天为1个周期。评价疗效及不良反应。结果54例患者均可评价疗效。单药治疗组PRI例。RR4．8％，SDl0例，疾病控制率（DCR）52．4％，PD10例（47．6％）。中位无进展生存期3.8个月；联合治疗组PR4例，RR12．1％，SD20例，疾病控制率（DCR）72．7％，PD9例（27．3％）。中位无进展生存期4．8个月。与药物相关的不良反应主要为：I／II度骨髓抑制、胃肠道反应。结论培美曲塞或与铂类联合治疗晚期复治非小细胞肺癌有效，不良反应轻微、可耐受。

Objective Pemetrexed was approved for the second-line treatment of advanced non-small cell lung cancer as a multi-target antifolate chemotherapeutic drug. The aim of this study was to evaluate efficacy and toxicity of pemetrexed alone or pemetrexed combined with cisplatin / carboplatin in the treatment of advanced chemo-recurrent non-small cell lung cancer. Methods Fifty-four advanced non-small-cell lung cancer patients, which had been treated with at least one standard platinum-based regimen previously, were treated with pemetrexed alone or pemetrexed combined with cisplatin / carboplatin. Twenty-one cases were enrolled in the pemetrexed alone group and thirty-three in the pemetrexed combined with eisplatin / carboplatin group. Patients received pemetrexed 500 mg/m2 on day 1 every 21 days in single agent group. Patients received pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 or carboplatin AUC=5 on day 1 every 21 days in combination group. Results All patients were evaluated response and toxicity. Among the single agent group, no case got CR, 1 case got PR （4.8%）, 10 SD, and 10 PD （47.6%）. Response rate and disease control rate were 4.8% and 52.4%. The median progression-free survival time was 3.8 months. Among the combination group, no case got CR, 4 cases got PR （12.1%） , 20 SD, and 9 PD （27.3%） . Response rate and disease control rate were 12.1% and 72.7%. The median progression-free survival time was 4.8 months. The main toxicities were grade 1 to 2 myelosuppression and gastrointestinal toxicities. Conclusion Pemetrexed alone or pernetrexed combined with cisplatin / carboplatin is effective in advanced, previously treated non-small-cell lung cancer, and it is well tolerated with minimal adverse events.