一线培美曲塞联合顺铂治疗晚期肺腺癌的临床观察

Pemetrexed combined with cisplatin as first-line treatment of advanced lung adenocarcinoma

目的比较一线培美曲塞联合顺铂与多烯紫杉醇联合顺铂方案治疗晚期肺腺癌患者的疗效、不良反应及生存质量。方法经病理或细胞学确诊的晚期肺腺癌患者共87例,随机分为培美曲塞治疗组和多烯紫杉醇治疗组。培美曲塞治疗组45例:培美曲塞500 mg/m2,顺铂75 mg/m2,静脉滴注,均第1天给药,并口服地塞米松、叶酸和肌肉注射维生素B12治疗,21d为1周期。多烯紫杉醇治疗组42例:多烯紫杉醇75mg/m2,顺铂75 mg/m2,静脉滴注,均第1天给药,21d为1周期。完成治疗2个周期以上的患者进行临床疗效、不良反应及生存质量评估。结果培美曲塞治疗组和多烯紫杉醇治疗组有效率(RR)分别为55.6%、42.9%,肿瘤控制率(TGCR)分别为80%、59.5%(P<0.05)。培美曲塞治疗组骨髓抑制及消化道不良反应较轻,患者生存质量改善优于多烯紫杉醇治疗组(P<0.05)。结论培美曲塞联合顺铂一线治疗晚期肺腺癌与多烯紫杉醇联合顺铂方案相比,疗效较好,骨髓抑制及消化道不良反应较轻,患者生存质量改善更显著。晚期肺腺癌患者可从一线培美曲塞联合顺铂治疗中获益。

Objective To evaluate the clinical efficacy,adverse effect and life quality of pemetrexed combined with cisplatin or docetaxel combined with cisplatin as first-line treatment of advanced lung adenocarcinoma.Methods Eighty-seven patients with advanced lung adenocarcinoma proved by pathology or cytology were divided randomly into group P（pemetrexed combined with cisplatin） and group D（docetaxel combined with cisplatin）.45 cases in group P received pemetrexed at a dose of 500 mg/m2 and cisplatin of 75 mg/m2 intravenousely on day 1,repeated every 21days for one cycle.Folic acid,vitamin B12 and oral dexamethasone were also given in group P.42 cases in group D received docetaxel at a dose of 75mg/m2 and cisplatin intravenousely on day 1,repeated every 21days for one cycle.The clinical efficacy,adverse effect and life quality were evaluated for patients who had completed at least two cycles of treatment.Results In group P and group D,the effective rate of treatment was 55.6% and 42.9% respectively,and the disease control rate was 80% and 59.5%（P0.05）.Compared to group D,the side effects such as bone marrow suppression and gastrointestinal reactions are milder and survival quality is higher in group P（P0.05）.Conclusion Compared with the treatment of docetaxel combined with cisplatin,pemetrexed combined with cisplatin as first-line treatment of advanced lung adenocarcinoma achieves better clinical efficacy and higher life quality,as long as milder side effects.Patients with advanced lung adenocarcinoma could benefit from pemetrexed combined with cisplatin as first-line treatment.