自体DC-CIK细胞联合培美曲塞治疗老年非小细胞肺癌的疗效与安全性

Efficacy and safety of autologous DC and CIK cells comined Pemetrexed in the treatment of elderly patients with non-small cell lung cancer

目的:观察晚期老年非小细胞肺癌患者行自体细胞因子诱导的树突细胞(DC)及杀伤细胞(CIK细胞)联合培美曲塞二钠治疗的临床疗效及毒副反应。方法:经病理学或细胞学确诊的老年(65～79岁)晚期ⅢA～Ⅳ期非小细胞肺癌47例,24例联合治疗组患者应用自体外周血进行CIK细胞及DC细胞扩增,并应用流式细胞术检测其CIK/DC-CIK表型,然后采取静脉回输方法,进行自体CIK细胞及DC细胞联合培美曲塞二钠500 mg/m2治疗,静脉滴注,第1天;23例单纯化疗组患者接受培美曲塞二钠单药500 mg/m2治疗,静脉滴注,第1天。21天为1个周期,接受2个周期以上化疗,每2个周期评估疗效、不良反应。结果:联合治疗组和单纯化疗组临床获益率(疾病控制率)分别是66.67%和56.52%(P<0.05),中位生存期分别是9.3个月和8.7个月(P>0.05),1年生存率分别是27.6%和25.4%(P>0.05)。两组主要的毒副反应是骨髓抑制和胃肠道反应以及乏力,其中联合治疗组中性粒细胞降低发生率明显低于单纯化疗组(Ⅰ～Ⅱ度:9.05%vs 19.09%,P<0.05,Ⅲ～Ⅳ度:2.52%vs 9.27%,P<0.05);联合治疗组胃肠道反应发生率也明显低于单纯化疗组(Ⅰ～Ⅱ度:6.29%vs 15.09%,P<0.05;Ⅲ～Ⅳ度:2.76%vs 8.91%,P<0.05)。结论:联合治疗组和单纯化疗组治疗老年非小细胞肺癌疗效均较好,但联合治疗组具有更好的临床获益及更少的不良反应,并且具有更高的生存质量。

Objective： Observation of clinical efficacy and toxicity about advanced non-small cell lung cancer in the elderly patients with the treatment of autologous cytokine-induced dendritic cells （DC） and killer cells （CIK） combined Pemetrexed. Methods ： Elderly （65-79） patients with HIA-IV period non-small cell lung cancer 47 cases confirmed by pathology or cytology were enrolled into two groups ： 24 cases received the treatment of transfusing for autologous CIK and DC combined 500 mg/m2 Pemetrexed intravenously once a day, which came from the peripheral blood of themselves and amplified, during CIK/DC-CIK phenotype detection by flow cytometry, and another 23 patients received the treatment of 500 mg/m2 Pemetrexed intravenously once a day. 21 days is a period. 47 patients were given more than 2 periods of chemotherapy and evaluated of efficacy and toxicity every 2 periods. Results ： The effective rate （with a disease control rate） of combination therapy group（24 cases） and chemotherapy group（23 cases） was 66.67% and 56.52% （ P 〈 0.05 ） , median survival was 9.3 and 8.7 months（ P 〉 0.05 ） , the 1 -year survival rate was 27.6% and 25.4% （ P 〉 0.05 ）. The main toxicity of two therapys .was bone marrow suppression, gastrointestinal reaction and weak. Granulocytopenia was significantly less occurred in combination therapy group than in chemotherapy group （ I - II ： 9.05% vs 19.09% ,P 〈0.05 ; III-IV ： 2.52% vs 9.27% , P 〈 0.05 ）. Gastrointestinal reaction was significantly less occurred in combination therapy group than in chemotherapy group （ I - II ： 6.29 % vs 15.09%, P 〈 0.05 ; III - IV ： 2.76% vs 8.91%, P 〈 0.05 ）. Conclusion： The therapeutic effects of elderly non-small cell lung cancer patients accepted either combination therapy or chemotherapy arc good, but the combination therapy group shows the better efficiency, the fewer toxicity and a higher quality of life than chemotherapy group.