培美曲塞单药或联合奈达铂治疗对卡铂及紫杉醇耐药的复发晚期上皮性卵巢癌

Pemetrexed alone or in combination with nedaplatin in recurrence and carboplatin/paclitaxel resistance advanced epithelial ovarian carcinoma

目的观察培美曲塞单药或联合奈达铂治疗对卡铂及紫杉醇耐药的复发晚期上皮性卵巢癌的疗效和不良反应。方法将对卡铂及紫杉醇耐药的复发晚期上皮性卵巢癌50例随机分为A、B两组,A组第1天给予培美曲塞500m g/m2,每21天重复;B组第1天给予培美曲塞500m g/m2、奈达铂80m g/m2,每21天重复;直到疾病恶化为止。结果两组均无完全缓解病例,部分缓解A组4例、B组11例,稳定A组15例、B组11例,病情恶化A组6例、B组3例,总有效率A组16.0%、B组44.0%,差异有统计学意义(2χ=4.667,P=0.031)。中位肿瘤恶化时间A组2.4个月,B组3.6个月(P=0.046)。中位生存期A组6.0个月,B组7.5个月(Log-rank,P=0.048)。不良反应主要是骨髓抑制。结论培美曲塞单药或联合奈达铂治疗对卡铂及紫杉醇耐药的复发晚期上皮性卵巢癌均有效,培美曲塞联合奈达铂总有效率、中位肿瘤恶化时间及中位生存期均明显好于培美曲塞单药,骨髓抑制较明显,但可以耐受。

Objective To observe the efficacy and side effect of pemetrexed（PEM） alone or in combination with nedaplatin（NDP） in recurrence and carboplatin（CBP） and paclitaxel（PTX） resistance advanced epithelial ovarian carcinoma.Methods Fifty patients with recurrence and CBP and PTX resistance advanced epithelial ovarian carcinoma were randomly divided into groups A and B. Twenty-five patients in group A were treated only with PEM 500 mg/m^2 on day 1 which was repeated every 21 days, and twenty-five patients in group B were treated with PEM 500 mg/m^2,and NDP 80 g/m^2 on day 1 which was repeated every 21 days, until disease had progressed.Results No patients achieved complete response（CR） in either group but 4 patients in group A（or 11 patients in group B） achieved a partial response（PR） and 15 patients in group A（or 11 patients in group B） achieved a stable disease（SD） and the overall response rate（ORR） was 16.0% in group A and 44.0% in group B（χ^2=4.667,P=0.031）. The median time to progression（mTTP） was respectively 2.4 months in group A and 3.6 months in group B（P=0.046） and the median survival（mS） was 6.0 months in group A and 7.5 months in group B（Log-rank, P=0.048） .The major adverse effect was marrow depression. Conclusions PEM alone or in combination with NDP were effective for recurrence and CBP/PTX resistance in advanced epithelial ovarian carcinoma.The ORR, mTTP and mS of PEM in combination with NDP was significantly better than PEM alone and marrow depression was marked,but tolerated.