培美曲塞与多西他赛联合铂类治疗晚期非小细胞肺癌临床观察

Clinical comparative studies of pemetrexed combined with docetaxel in the treatment of advanced nonsmall-cell lung cancer

目的比较培美曲塞与多西他赛联合铂类一线治疗晚期非小细胞肺癌（NSCLC）的效果及毒副反应。方法102例晚期NSCLC患者随机分为培美曲塞＋顺铂（PC）组52例和多西他赛＋顺铂（TP）组50例。Pc组：培美曲塞500mg／m。静脉滴注，第1天；顺铂75mg／m。静脉滴注，第1～3天。TP组：多西他赛75mg,／m。静脉滴注，第1天；顺铂75mg／m。静脉滴注，第1～3天。两组均21d为1周期。比较两组疾病控制率、无进展生存期、中位生存期和1年生存率。结果102例患者均可评价疗效及毒副反应，无完全缓解病例，部分缓解43例，稳定38例，进展21例。Pc组与TP组的疾病控制率[80．8％（42／52）与78．0％（39／50）]、无进展生存期（5．69个月与4．71个月，P=0．334）、中位生存期（10．49个月与10．48个月，P=0．851）和1年生存率（32．O％与24．0％，X。=1．59，P=0．210）差异均无统计学意义。两组的不良反应主要为骨髓抑制和消化道反应，培美曲塞可致白细胞数下降（P=0．010）、脱发（P=0．004）、发热（P=0．024）、皮疹（P=0．048），两组比较差异均有统计学意义；而两组在贫血（P=0．873）、血小板减少（P=0．541）、恶心／呕吐（P=0．114）、肝毒性（P=0．403）、肾毒性（P=0．541），两组差异无统计学意义。结论培美曲塞与多西他赛联合顺铂治疗晚期肺腺癌的临床疗效相当，但可降低毒副反应发生率。

Objective To investigate the clinical efficacy and toxicity of comparison of the pemetrexed combined with cisplatin and docetaxel of advanced non small cell lung cancer（NSCLC）. Methods The clinical data of 102 patients with advanced NSCLC were retrospectively analyzed. Fifty-two patients received pemetrexed combined with cisplatin （ Group PC） （ pemetrexed 500 mg/m2 intravenous drip in first day, cisplatin 75 mg/m2, intravenous drip in first day to third day, repeated every 21 days） ; Other 50 patients received the docetaxel combined with cisplatin （Group TP） （docetaxel 75 mg/m2 intravenous drip in first day, cisplatin 75 mg/m2 ntravenous drip in first day to third day,repeated every 21 days）. The disease control rate （DCR） ,progress free survival, median survival time and 1 year survival rate were compared between two groups. Results The efficacy and side effects of all the patients could be evaluated. There was no case with complete remission,43 of partial remission,38 cases of stable and 21 cases of progress. No statistical significance were found between the two groups in DCR （80. 8% （42/52） vs. 78.0% （39/50）） ,progression-free survival（5.69 vs. 4.71 months,P = 0. 334） ,median survival time （ 10. 49 vs. 10. 48 months, P = 0. 851 ） and 1 year survival rate （ 32. 0% vs. 24.0%, X~ = 1.59 ,P = 0. 210）. The most common toxicities were arrest of bone marrow and alimentary tract reactions. Pemetrexed could reduce the Leukopenia （P =0. 010） ,the alopecia （P = 0. 004） ,the febrile （P = 0. 024） and tetter （ P = 0. 048 ） ; but no significant difference was found in anaemia （ P = 0. 873 ）, thrombocytopenia （ P = 0. 541 ）, nausea and vomiting （ P = 0. 114） and impaired liver function （ P = 0. 403 ） and impaired renal function （P = 0. 541 ）. Conclusion Pemetrexed and docetaxel combined with cisplatin for the treatment of advanced NSCLC have similar treatment effects, and the side effect of pemetrexed combined cisplatin is lower.