培美曲赛联合奈达铂对一线化疗失败的晚期尿路上皮癌的有效性及安全性分析

The efficacy and safety of pemetrexed and nedaplatin in salvage chemotherapy of advanced urinary carcinoma

目的评价培美曲赛联合奈达铂治疗一线GC方案治疗失败的局部晚期或转移性尿路上皮癌患者的疗效和不良反应。 方法回顾性分析2015年9月至2017年3月收治的一线GC方案治疗后复发或进展的11例局部晚期或转移性尿路上皮癌患者的临床资料。男6例，女5例；年龄56～80岁，中位年龄65岁；6例起源于膀胱，4例起源于肾盂，1例起源于输尿管；ECOG评分0分7例，1分3例，2分1例。肺转移6例，肝转移2例，骨转移2例，淋巴结转移6例，多处转移7例。行培美曲赛二钠500 mg/m2，静脉滴注30 min，第1天；奈达铂25 mg/m2，静脉滴注，第1～3天，21 d为1个周期，2～3个周期后评价疗效和不良反应。 结果11例患者行1～6个周期化疗，平均3.3个周期。11例中完全缓解2例（18.2%）,部分缓解5例（45.5%）,疾病稳定2例（18.2%）,疾病进展2例（18.2%）,总有效率63.6%（7/11）。主要不良反应为贫血（6例）、白细胞下降（5例）、恶心呕吐（6例）和皮疹（5例）,均为1～3级。无治疗相关性死亡病例。 结论培美曲赛联合奈达铂方案治疗晚期尿路上皮癌的疗效肯定，不良反应较轻，可作为一线治疗失败后的可选择的方案。

ObjectiveTo evaluate the efficacy and toxicity of pemetrexed and nedaplatin in the treatment of patients with locally advanced or metastatic urothelial cell carcinoma who failed a first-line GC regimen. MethodsA total of 11 patients with locally advanced or metastatic urothelial carcinoma failed with first-line treatment of GC regimen were included in the present study. There were 6 males and 5 females, aged 56-80 years old, median age was 65 years old. Six patients′ primary tumors were in bladder, 4 in the renal pelvis, 1 ureter. There were 7 cases with ECOG score 0 point, 3 cases 1 point, 1 case 2 points. Patients received pemetrexed 500 mg/m2 intravenously on the 1st day, and nedaplatin 25mg/m2 from the 1st to 3th day every 21 days. The evaluation of efficacy and adverse reactions were carried out after 2 to 3 cycles. ResultsEleven patients received 1 to 6 cycles （mean 3.3 cycles） treatments. There were 2 cases （18.2%） complete remission, 5 cases （45.5%） partial remission, 2 cases （18.2%） no change and 2 cases （18.2%） progressed. The total effective rate was 63.6%. The main adverse events were anemia （6 cases）, leukopenia （5 cases）, nausea and vomiting （6 cases） and rash （5 cases） , all of which were mild to moderate. No treatment-related death occurred. ConclusionsPemetrexed and nedaplatin regimen could be effective in the treatment of advanced urothelial carcinoma after first-line chemotherapy failed. The side effect is mild.