重组人血管内皮抑素联合培美曲塞一线治疗老年性肺腺癌的临床观察

Endostar combined with pemetrexed for first-line treatment of advanced lung adenocarcinoma in elderly patients

目的：观察重组人血管内皮抑素（恩度）联合培美曲塞一线治疗老年性肺腺癌的疗效及不良反应。方法：将60例未经过放化疗的ⅢB～Ⅳ期肺腺癌患者，随机分为试验组和对照组：试验组26例（男15例，女11例），采用恩度联合培美曲塞方案；对照组34例（男20例，女14例），采用培美曲塞单药方案。两组患者计划完成4～6个周期化疗，每2个周期评价疗效。结果：试验组共完成80个周期，对照组共完成115个周期。近期疗效：试验组和对照组缓解率（response rate，RR）分别为23.1%vs.14.7%，差异有统计学意义（P〈0.05），两组疾病控制率（disease control rate，DCR）无统计学意义（P〉0.05）。试验组控制胸腔积液的疗效明显优于对照组（P〈0.05）。试验组中取得DCR疗效的患者微血管密度（microvascular density，MVD）计数较高（P=0.03），而对照组未观察到此现象。远期疗效：两组中位无进展生存期（mid-progression free survival，mPFS）、中位生存期（median survival，mOS）及不良反应无统计学差异（P〉0.05）。结论：恩度联合培美曲塞治疗老年性肺腺癌可以提高RR，更好地控制恶性胸腔积液，未增加化疗的不良反应。MVD可作为恩度的疗效预测因子。

Abstract： Objective：A study was conducted to observe and compare the efficacy and safety of endostar combined with peme-trexed in elderly patients with advanced lung adenocarcinoma. Methods：Sixty advanced lung adenocarcinoma （ⅢB-Ⅳ） patients who never received any therapy were included. The patients were divided into two groups. One group comprised endostar treatment com-bined with pemetrexed （26 cases of males, 15 cases of females, and 11 cases of individuals aged 65 years old to 78 years old）, and the other group comprised pemetrexed only （34 cases of males, 20 cases of female, and 14 cases of individuals aged 65 years old to 78 years old）. The two groups were treated for 4 to 6 cycles, and evaluation of treatments was performed every two cycles. Results：The endostar group was re-treated for 80 cycles, and the average cycle was 3.1. The group without endostar was re-treated for 115 cycles. The short-term effects are as follows. The total effective rates （RRs） in the experimental and control groups were 23.1%and 14.7%, re-spectively, and the difference was statistically significant （P〈0.05）. The disease control rate （DCR） was not significantly different （P〉0.05）. For pleural effusion, RR and DCR were significantly better in the experimental group than in the control group （P〈0.05）. In the experimental group, compared with PD, the microvessel density （MVD） in the DCR showed higher expression, and a statistically signif-icant difference （P=0.03） was observed. In the control group, compared with PD, the MVD in the DCR also showed higher expression, but no significant difference （P=0.73） was observed. The long-term effects were as follows： median progression-free survival （PFS）, median survival, and side effects between the two groups were not significantly different （P〉0.05）. Conclusion： Endostar combined with pemetrexed showed increase in total efficiency in elderly patients with lung adenocarcinoma, and malignant pleural effusion was controlled without increasing the toxicity of chemotherapy. MVD can be used as a predictor of Endostar application.