培美曲塞或雷替曲塞联合顺铂一线治疗恶性胸膜间皮瘤的疗效与安全性观察

Efficacy and safety of pemetrexed or raltitrexed in combination with cisplatin as first-line chemotherapy for malignant pleural mesothelioma

目的探讨雷替曲塞或培美曲塞联合顺铂一线治疗恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)的疗效和安全性。方法 2010年1月-2013年1月辽宁医学院附属第一医院肿瘤科收治的36例失去根治性手术机会的MPM患者,随机分为两组,RP组18例接受雷替曲塞/顺铂方案,PP组18例接受培美曲塞/顺铂方案,比较两组的疗效和不良反应。结果 RP组和PP组客观有效率(22.2%vs 38.9%)、疾病控制率(72.2%vs 83.3%)、中位无疾病进展生存期(5.0个月vs 5.5个月)和中位总生存期(11.2个月vs 11.8个月)差异均无统计学意义(P>0.05)。虽然PP组血液学毒性发生率高于RP组,但两组不良反应发生率均无统计学差异(P>0.05)。结论两方案一线治疗MPM的临床疗效相当,对于无经济条件而接受培美曲塞或希望尽可能避免血液学毒性的患者,雷替曲塞/顺铂方案可作为优选方案。

Objective To evaluate the efficacy and safety of pemetrexed or raltitrexed in combination with cisplatin as first-line chemotherapy for malignant pleural mesothelioma. Methods A total of 36 patients with malignant pleural mesothelioma who were not candidates for curative surgery admitted to Department of Oncology, First Affiliated Hospital of Liaoning Medical University from January 2010 to January 2013 were randomly divided into RP group （n=18） and PP group （n=18）. In RP group, raltitrexed in combination with cisplatin was applied, while in PP group, pemetrexed combined with cisplatin was administered. The efficacy and adverse reactions in two groups were observed and compared. Results No statistically significant differences were found in the objective response rate, disease control rate, median progression-free survival and median overall survival between RP group and PP group （22.2% vs 38.9%, 72.2% vs 83.3%, 5.0 months vs 5.5 months, 11.2 months vs 11.8 months, P 〉 0.05）. The incidence of hematological toxicity was higher in PP group than in RP group, but no statistically differences in adverse reaction were found between the two groups （P 〉 0.05）. Conclusion The clinical efficacy of the two regimens as first-line chemotherapy for malignant pleural mesothelioma is similar, raltitrexed/cisplatin is a preferred regimen for patients who can not afford pemetrexed or try to avoid hematological toxicity as much as possible.