培美曲塞与多西他赛在晚期非小细胞肺癌靶向治疗失败后挽救化疗中的疗效分析

Efficacy and toxicity of pemetrexed versus docetaxel in patients with advanced non-small cell lung cancer previously treated with EGFR-TKIs

目的：比较培美曲塞与多西他赛在非小细胞肺癌（NSCLC）靶向治疗失败后挽救化疗中的有效性和安全性。方法回顾性分析本院收治的67例靶向治疗失败行挽救化疗的 NSCLC 患者，根据挽救化疗方案分为培美曲塞组（培美曲塞500 mg／ m2， d1， n＝36）和多西他赛组（多西他赛75 mg／ m2， d1， n＝31），21天为1周期。分析两组的近期疗效、毒副反应和远期疗效，采用 Cox 风险比例模型分析影响预后的因素。结果67例患者均可评价近期疗效。培美曲塞组和多西他赛组的有效率分别为19．4％和12．9％，疾病控制率分别为58．3％和41．9％，差异均无统计学意义（P＞0．05）。培美曲塞组的3～4级毒副反应包括白细胞减少、血小板减少、皮疹和转氨酶升高的发生率均低于多西他赛组（P＜0．05）。培美曲塞组的中位无进展生存期（PFS）为6．4个月，高于多西他赛组的4．7个月（P＜0．05），但两组的中位总生存期（OS）的差异无统计学意义（10．2个月vs．9．8个月，P＞0．05）。 Cox 风险比例模型显示，年龄、临床分期、病理类型、PS 评分和挽救方案均为影响靶向治疗失败 NSCLC患者的 PFS 的独立因素。结论培美曲塞在 NSCLC 靶向治疗失败挽救化疗中的近期疗效与多西他赛相当，且中位 PFS 略有延长，毒副作用低，值得临床上推广使用。

Objective To explore the efficacy and toxicity of pemetrexed versus docetaxel in patients with advanced non-small cell lung cancer（NSCLC） previously treated with epidermal growth factor receptor tyrosine kinase inhibitors（EGFR-TKIs）. Methods In this retrospective study, 67 cases of NSCLC patients failed to EGFR-TKIs were enrolled. According to the treatment regimen, the pa-tients were assigned to receive docetaxel（75 mg/ m2 d1 , n= 31） or pemetrexed（500 mg/ m2 d1 , n= 36） with 21 days for a cycle. The efficacy was evaluated according to response evaluation criteria in solid tumors（RECIST 1. 1）. The toxicity was evaluated by interna-tional standard adverse reaction NCI CTC 3. 0 version. The long-term survival was followed up and the Cox hazard regression model to analyze the influencing factors for the prognosis. Results All patients can be evaluated for the short-term efficacy. The response rates of pemetrexed group and docetaxel group were 19. 4% and 12. 9%, and disease control rates were 58. 3% and 41. 9% without signifi-cant difference（P〉0. 05）. In pemetrexed group, the incidence of grade 3-4 white blood cell reduction, thrombocytopenia, skin rash and elevated aminotransferase were all lower than that of docetaxel group（P〈0. 05）. The median progression free survival（PFS） was 6. 4 months in the pemetrexed group, higher than 4. 7 months in docetaxel group with significant differences（P〈0. 05）. No significant difference was observed in the median overall survival between both groups（P〉0. 05）. Factors affecting the PFS included age, clinical stage, pathological type, PS score and save program. Conclusion Similar efficacy was observed between pemetrexed and docetaxel in NSCLC patients failed to EGFR-TKIs. However, the median PFS was relatively high, and the side effects were slight and could be tol-erated in pemetrexed regiem. In view of the factors influencing the prognosis, it could be recommended to use in the treatment of the＆nbsp;patients.