培美曲塞联合铂类一线治疗非小细胞肺癌脑转移的临床观察

Pemetrexed combined with platinum as first-line treatment of advanced non-small cell lung cancer with brain metastasis

目的:观察培美曲塞联合铂类一线治疗非小细胞肺癌无症状脑转移的疗效和不良反应。方法:对30例经病理或细胞学检查确诊的晚期非小细胞肺癌无症状脑转移初治患者,一线进行培美曲塞联合顺铂或卡铂化疗:培美曲塞500 mg/m2(第1天),联合顺铂25 mg/m2(第1～3天)或卡铂(AUC=5)(第1天),每3周为1个周期。所有患者接受至少1个周期化疗。结果:30例可评价颅内转移灶的疗效:部分缓解10例(33.3%),疾病稳定14例(46.7%),疾病进展6例(20%),有效率为33.3%,疾病控制率为80%,颅内转移灶的中位至疾病进展时间为6.5个月。全身病灶的总体疗效:部分缓解7例(23.3%),疾病稳定14例(46.7%),疾病进展9例(30%),有效率为23.3%,疾病控制率为70%,全身病灶的中位无进展生存期为5个月。主要不良反应为骨髓抑制、胃肠道反应等,经对症处理后均能耐受。结论:培美曲塞联合铂类一线治疗非小细胞肺癌无症状脑转移疗效较好,不良反应轻微,值得进一步研究应用。

Objective：To evaluate the clinical efficacy and toxicity of pemetrexed combined with platinum as first-line treatment of advanced non-small cell lung cancer（NSCLC） with asymptomatic brain metastasis.Methods：A total of thirty chemotherapy-naive NSCLC patients with asymptomatic brain metastasis were enrolled in this study,and all of these patients had been confirmed with NSCLC by pathology or cytology.Patients received pemetrexed 500 mg/m^2 on day 1,and cisplatin 25 mg/m^2 for three days or carboplatin（AUC=5） on day 1.Every 3 weeks as one cycle.All patients who received 1 or more cycles could be evaluated.Results：Thirty patients were evaluable for objective response.Local cerebral response assessment showed that 10 patients（33.3%）got a partial response（PR）,14（46.7%） had a stable disease（SD） and 6（20%） had a progressive disease（PD）.The response rate was 33.3%,the disease control rate was 80%,and the median time to progression was 6.5 months.Overall lesion assessment presented that 7（23.3%）,14（46.7%）and 9（30%） patients got PR,SD and PD,respectively.The response rate was 23.3%,the disease control rate was 70%,and the progression-free survival was 5 months.The common adverse effects were hematological toxicity and gastrointestinal response,and the toxic reactions could be well controlled with relative therapy.Conclusion：Pemetrexed combined with platinum regimen is effective and well tolerable for advanced NSCLC with asymptomatic brain metastases.