培美曲塞与最佳营养支持治疗晚期非小细胞肺癌的疗效比较

Clinical observation of pemetrexed contrast to the best supportive care in the patients with advanced non-small cell lung cancer

背景与目的:肺癌是目前发病率最高的恶性肿瘤之一,肺癌中以非小细胞肺癌(non-small cell lung cancer,NSCLC)为主,化疗在晚期NSCLC中占主要地位,但对于老年晚期NSCLC的化疗目前存在争议。本研究旨在比较培美曲塞与最佳营养支持治疗在ECOG=2分且年龄≥70岁晚期NSCLC患者的临床疗效,并探讨培美曲塞的不良反应。方法:以84例ECOG=2分且年龄≥70岁的晚期NSCLC患者为研究对象,随机分为培美曲塞组(治疗组)和最佳营养支持治疗组(对照组)(n=42)。治疗组采用培美曲塞二钠,500 mg/m2,第1天,静脉滴注,3周为1个周期。对照组每天保证200 g葡萄糖供应,蛋白质根据患者体质量供给。近期疗效治疗组2个周期后评价,对照组2个月后评价。结果:治疗组完全缓解(CR)0例,部分缓解(PR)6例(14.3%),病情稳定(SD)21例(50.0%),病情进展(PD)13例(30.9%),客观有效率14.3%,疾病控制率64.3%。对照组CR 0例,PR 1例(2.4%),SD 15例(35.7%),PD 25例(60.9%),1例死亡,客观有效率为2.4%,疾病控制率为39.0%(P<0.05)。结论:培美曲塞在ECOG=2分且年龄≥70岁晚期NSCLC患者的疗效优于最佳营养支持治疗,并且不良反应轻,患者可以耐受。

Background and purpose：Lung cancer is the one with the highest incidence tumors, is mainly appeared to be non-small cell lung cancer（NSCLC）. The main treatment method is chemotherapy. However, it is controversial whether using chemotherapy in the patients of advanced NSCLC. The present study aimed to observe the efifcacy and toxicity of pemetrexed contrast to the best supportive care in the NSCLC patients of ECOG=2 and older than 70.Methods：A total number of 84 patients of ECOG=2 and older than 70 with advanced NSCLC were randomly assigned into two groups. The study group accepted pemetrexed, 500 mg/m2,every 3 weeks as a cycle, and the control group was given 200 g glucose supply and protein according to patients’ weight every day. Evaluation of the study group was performed at end of 2 cycles and the control group was evaluated after 2 months.Results：There was no CR patient in 2 groups. In the study group there were 6 patients of PR （14.3%）, 21 patients of SD （50%） and 13 patients of PD （30.9%）, the effective rate was 14.3%, and the disease control rate was 64.3%. There were 1 patient of PR （2.4%）, 15 patients of SD （35.7%）, 25 patients of PD （60.9%）, 1 patient of death, the effective rate was 2.4% and the disease control rate was 39.0% in the control group （P〈0.05）.Conclusion：The study group has better treatment effect and adverse reaction in patients of ECOG=2 and older than 70 with advanced non-small-cell lung cancer and the toxicity could be tolerated.