培美曲塞在晚期非小细胞肺癌二线治疗中的应用

Application of pemetrexed in the second-line treatment for advanced non-small cell lung cancer

目的探讨培美曲塞单药或联合顺铂作为二线治疗方案治疗晚期复发或进展的非小细胞肺癌患者的疗效及毒副反应。方法回顾性总结接受培美曲塞二线治疗的50例晚期非小细胞肺癌患者,按照用药情况分为单药治疗组22例及联合铂类治疗组28例。评价2组近期疗效及不良反应。结果 50例患者均可评价疗效。2组均无CR病例。单药治疗组PR2例,SD10例,PD10例,有效率(CR+PR)9.1%,疾病控制率(CR+PR+SD)54.5%,中位无进展生存期3.8个月;联合治疗组PR3例,SD13例,PD8例,有效率7.1%,疾病控制率71.4%,中位无进展生存期4.8个月。2组比较,有效率及中位无进展生存期差异无统计学意义(P均>0.05),联合铂类治疗组疾病控制率较高(P<0.05)。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、皮疹,与联合铂类治疗组比较,单药治疗组的副作用(红细胞减少、消化道反应)较低(P<0.05)。结论晚期非小细胞肺癌的二线治疗方案可选择培美曲塞单药或联合顺铂,安全性相对较好,但是两药联合治疗方案毒副反应略有增加。

Objective To evaluate the efficacy and adverse effect of pemetrexed single-agent or pemetrexed combined with cisplatin in the treatment of advanced recurrent or progressive non-small cell lung cancer （NSCLC）. Methods Fifty advanced NSCLC patients failed to previous general chemotherapy of at least 2 standard regimens including platinum were randomly allocated to treated with pemetrexed alone group （ single agent group, n = 22 ） and pemetrexed combined with cisplatin group （ combination group, n = 28 ）. The short-term efficacy and adverse effects after 2 courses of treatment were assessed. Results The therapeutic effect of all patients could be evaluated. There were no CR cases in two groups. In single agent group, there were 2 case in PR, 10 cases in SD, 10 cases in PD ; Reactive rate （RR） and disease control rate （DCR） were 9.1% and 54.5 % respectively; The median progression-free survival time was 3.8 months. In combination group, there were 3 cases in PR, 13 cases in SD and 8 cases in PD;RR and DCR were 7.1% and 71.4% respectively;The median progression-free survival time was 4.8 months. There were no significant difference in RR and median progression-free survival time between single agent group and combination gvoup（ all P 〉0. 05 ）. Compared with single agent group, DCR was higher in combination group （P 〈 0. 05）. The main drug-related adverse reactions were grade I/II bone marrow inhibition, gastrointestinal response and rash. Compared with combination group, some adverse effects such as decrease of erythrocyte count and gastrointestinal responses were lower in single agent group （P 〈 0. 05）. Conclusions Either pemetrexed or pemetrexed plus cisplatin has good efficacy and safety for treating advanced NSCLC as second-line treatment regimen, but the adverse effects of pemetrexed combined with cisplatin regimen slightly increase compared with pemetrexed alone.