培美曲塞作为三线药物对非小细胞肺癌的治疗效果

Effect of pemetrexed as a third- line drug for the treatment of non-smaU cell lung cancer

目的探讨培美曲塞作为三线药物对于一线和二线治疗失败的晚期非小细胞肺癌（NSCLC）的治疗效果。方法对17例一线含铂化疗及二线表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）治疗无效后的NSCLC患者给予单药培美曲塞（600mg／m^2第1天，21d为1个疗程）作为三线治疗，平均每例患者治疗周期中位数为6个疗程。观察疗效并分析患者性别、身体状态、给药周期数、EGFR基因型等对培美曲塞疗效的影响。结果17例患者中9例部分缓解，5例稳定，3例进展。中位疾病进展时间及总生存期为113d及321d。EGFR基因型不影响培美曲塞的疗效，患者耐受良好。结论培美曲塞对一般状态良好的NSCLC患者在其对一线含铂化疗及二线TKIs靶向治疗无效时可作为三线药物，且与顺铂和KTIs没有交叉耐药。

Objective To observe the effect of pemetrexed as a salvage chemotherapy for locally advanced or metastatic non-squamous non-small cell lung cancer （NSCLC） after failure of multiple therapies. Methods We retrospectively evaluated the efficacy of pemetrexed in 17 patients with advanced NSCLC, who had failed at least platinum-based doublet combinations and erlotinib or gefitinib. The patients were given single drug pemetrexed q21d dl （600 mg/m^2） as a third line therapy. Through the analysis of performance status, number of cycles given, EG- FR and K-ras mutation status, best response, adverse reactions, time to progression （TYP） and overall survival （OS） were used to assess the effects. A median of 6 cycles of infusion was given. Results Nine out of 17 patients experienced partial response, Five cases were stable and three were progressed. The TTP and OS of salvage peme- trexed therapy were 113 and 321 days, respectively. The EGFR mutation status did not affect its efficacy. It was well-tolerated and required no dose modification. Conclusion Pemetrexed is a good option for patients with good performance status who have failed platinum- and taxane-containing regimens and EGFR tvrosine kinase inhibitors.