培美曲赛联合IL-2治疗恶性胸腔积液的临床研究

Treatment of malignant pleural effusion by Pemetrexed combined with Interleukin-2

目的:观察引流胸腔积液后,培美曲赛联合白介素-2(IL-2)腔内注射治疗恶性胸腔积液的疗效及安全性。方法:将35例恶性胸腔积液患者分为联合治疗组(n=20,包括肺腺癌13例、恶性胸膜间皮瘤4例和乳腺癌3例)和单药治疗组(n=15,包括肺腺癌12例、恶性胸膜间皮瘤1例和乳腺癌2例)。先行胸腔置管引流,待积液引净、肺复张后,联合治疗组经导管注入培美曲赛200mg和IL-2 3×106 U,单药治疗组仅注入IL-2 3×106 U,去枕平卧后每10～15min转动体位,共翻身3圈,保留48h后抽净积液并拔管。结果:联合治疗组CR 14例(70.0%),PR 4例(20.0%),NC 2例(10.0%),总有效率90.0%。单药治疗组CR 3例(20.0%),PR 4例(26.7%),NC 8例(53.3%),总有效率46.7%。随访3和6个月后,联合治疗组SD为88.9%和77.8%,单药治疗组为57.1%和28.6%。两组均无骨髓抑制、过敏反应和>2cm的胸膜增厚发生。联合治疗组有3例(15.0%)出现轻度恶心和胃纳减低,甲氧氯普胺和维生素B6治疗后好转,单药治疗组无胃肠反应发生;联合治疗组有6例(30.0%)出现轻度胸痛,7例(35.0%)有低热,单药治疗组有4例(26.7%)轻度胸痛,5例(33.3%)低热,应用新癀片或吲哚美辛栓剂治疗后均得到控制。结论:培美曲赛联合IL-2治疗恶性胸腔积液安全、有效,值得临床推广应用。

OBJECTIVE： To observe the clinical efficacy and safety of intrapleural injection of Pemetrexed combined with Interleukin-2 for malignant pleural effusion. METHOSDS： Thirty-five patients with malignant pleural effusion were divided into combination group（20 cases,including 13 with lung adenocarcinoma, 4 with malignant pleural mesothelioma, 3 with breast cancer） and single-drug group（15 cases,including 12 with lung adenocarcinoma, 1 with malignant pleural mes- othelioma,2 with breast cancer）. All of the patients received closed drainage after percutancous thoracocentesis. And 200 mg of Pemetrexed and 3 million units of Interleukin-2 were injected through catheter into thoracic cavity in combina- tion group,and 3 million units of interleukin-2 only were done in single-drug group afer the effusion had been drained cleanly and the lung was reexpanded completely. The patients must rotate positions every 10-15 min in bed without pil- lows for total of 3 cycles. The residual effusion would be drawn out after the drugs had been reserved for 48 h,and the catheter would been pulled out finally. RESULTS.. In combination group, 14（70.0%） cases were determined for CR（com- plete response） ,4（20.0%） cases for PR（partial response） ,2（10.0%） eases for NC（no change） ,and the ORR（overall response rate） was 90.0%. In single-drug group, 3 （20.0K） cases were determined for CR, 4 （26. 7%） eases for PR, 8 （53.3 % ） cases for NC, and the ORR was 46.7 %. After 3-month and 6-month follow-up, the rate of SD（stable disease） in combination group were 88.9% and 77.8% respectively,and that in single-drug group were 57.1% and 28.6%. There were no bone marrow suppression, anaphylaxis and pleural thickening large than 2 cm occurred in two groups. Only 3 （15.0 %） cases in combination group and none in Single-drug group occurred mild nausea and slightly reduction of appetite which acquired improvement after the treatment by Metoclopramide and Vitamin B6. There were 6（30.0%） eases in corn bination group, 4 （26.7 % ） cases in single-drug group who had mild chest pain and 7 （35.0 %） cases in combination group, 5（33.3%） eases in single-drug group had low fever. The chest pain and fever can be controlled by Xinghuangpian or In domethacin suppository. CONCLUSION： Treatment of malignant pleural effusion by Pemetrexed combined with Interleu- kin-2 is safe and effective,and is worthy of clinical application.