培美曲塞或紫杉醇联合奈达铂治疗晚期肺腺癌的疗效对比及安全性评价

Effectiveness and Safety of Nedaplatin-based Pemetrexed and Platinumbased Paclitaxel Treatment in Patients with Advanced Lung Adenocarcinoma

目的对比培美曲塞(Pemetrexed,PEM)联合奈达铂(Nedaplatin,NDP)和紫杉醇(Paclitaxel,PTX)联合奈达铂治疗晚期肺腺癌的临床疗效及毒副反应。方法将76例确诊晚期肺腺癌(ⅢB期和Ⅳ期)患者随机分为观察组与对照组各38例,观察组采用培美曲塞联合奈达铂方案化疗,对照组采用紫杉醇联合奈达铂方案化疗,比较两组的临床疗效及毒副反应发生情况。结果培美曲塞组的有效率为44.7%(17/38),疾病控制率为84.2%(32/38);紫杉醇组的有效率为39.5%(15/38),疾病控制率为78.9%(30/38);两组有效率及疾病控制率均无统计学意义(P>0.05)。培美曲塞组的1年生存率为47.4%(18/38),紫杉醇组的1年生存率为42.1%(16/38),两组无统计学意义(P>0.05)。在白细胞减少、血小板减少、脱发等毒副反应方面,培美曲塞组的发生率明显低于紫杉醇组,两组有统计学意义(P<0.05)。结论培美曲塞或紫杉醇联合奈达铂治疗晚期肺腺癌均可取得良好的疗效,毒副反应均可耐受。相比紫杉醇联合奈达铂组,培美曲塞联合奈达铂方案治疗晚期肺腺癌具有更高的临床疗效倾向,并且毒副反应显著减少,可作为晚期肺腺癌化疗的优选方案,具有更高的临床应用与推广价值。

OBJECTIVE To explore the efficacy and safety of clinical trials of pemetrexed combined with neda- platin and paclitaxel with nedaplatin in treating advanced lung adenocarcinoma patients. METHODS 38 patients received nedaplatin plus pemetrexed （group PN） ,while 38 patients received nedaplatin plus paclitaxel （group TN） between June 2011 to June 2014. The two groups were compared in terms of median survival and adverse events to chemotherapy. RESULTS The mean ages of groups PN and TN were 51.3 and 52. 1 years, respectively. There was na difference between the two groups in terms of age, gender, stage, Karnofsky performance status, median hemoglobin and serum albumin levels. The treatment efficiency of PN group and TN group were 44.7% （ 17/38 ） and 39.5% （15/38） after chemotherapy（P 〉0. 05）. The disease control rate was 84. 2% （32/38） （95% CI） for group PN and 78.9% （30/38）（95% CI） for group TN （P 〉 0. 05 ）. The difference was no statistically significance between two groups in treatment efficiency and disease control rate. Hair loss, leukopenia（ grade HI -IV ） and thrombocytopenia （grade 111- IV ） in the PN group （23.68%, 13.16% ,7.89% ） were significantly lower than those in the TN group （94.73%, 36.84%, 26.32%） （P 〈 0.05 ）.The treatment was generally well tolerated in both groups. CONCLUSION PN and TN show similar efficacy for patients with advanced lung adenocarcinoma,howev- er, the toxicities in PN patients are lower than those in TN patients. Thus,pemetrexed combined with nedaplatin is an effective therapeutic regimen for patients with advanced lung adenocarcinoma.