培美曲塞治疗EGFR-TKI获得性耐药晚期NSCLC的疗效观察

Clinical efficacy of pemetrexed in the treatment of EGFR-TKI acquired resistance and late NSCLC

目的:观察培美曲塞治疗表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)获得性耐药晚期非小细胞肺癌(NSCLC)患者的临床疗效及安全性。方法:选取我院呼吸科及肿瘤科在2013年1月至2016年1月收治的60例二线治疗EGFR-TKI获得性耐药的晚期NSCLC腺癌患者,根据随机数字表法随机分为实验组41例,对照组19例,实验组给予吉非替尼联合培美曲塞进行治疗,对照组给予吉非替尼进行治疗,比较两组患者近远期疗效以及安全性。结果:治疗2个周期后,实验组客观缓解率高于对照组(43. 9%vs 26. 3%,P<0. 05);实验组中位无进展生存期高于对照组(7. 5个月vs 5. 0个月,P=0. 041 <0. 05);实验组的白细胞下降(26. 8%)、胃肠道反应(39. 0%)的发生率较对照组的白细胞下降(47. 4%)、胃肠道反应(63. 2%)的发生率明显下降(P <0. 05),但是实验组的皮疹(36. 6%)发生率较对照组的皮疹(21. 1%)发生率显著增高(P <0. 05)。结论:培美曲塞治疗EGFR-TKI获得性耐药晚期NSCLC患者的临床疗效确切,明显提高患者客观缓解率及中位无进展生存时间,降低化疗毒副反应。

Objective： To analyze the clinical efficacy and safety of pemetrexed in the treatment of advanced NSCLC patients with acquired resistance to EGFR-TKI. Methods： In the Department of Respiration and Oncology Department of our hospital,60 patients with advanced NSCLC adenocarcinoma with acquired resistance to EGFR-TKI in the second line of January 2013-January 2016 were randomly divided into 41 cases in the experimental group and 19 in the control group. The experimental group was treated with gefitinib combined with pimatrine,and the control group was given gefitinib. The short-term and long-term efficacy and safety of the two groups were compared.Results： After 2 cycles of treatment,the experimental group objective response rate was higher than the control group（ 43. 9% vs 26. 3%,P〈0. 05）. The median progression free survival was higher than the control group（ 7. 5 months vs 5. 0 months,P = 0. 041 0. 05）. Decrease in the experimental group of white blood cells（ 26. 8%）,the incidence of gastrointestinal reaction（ 39. 0%） was more obvious than the control group of white blood cells（ 47. 4%）,the incidence of gastrointestinal reaction（ 63. 2%）（ P〈0. 05）,but the experimental group the incidence of rash（ 36. 6%）was significantly higher than the control group rash（ 21. 1%）（ P〈0. 05）. Conclusion： Pemetrexed treatment of EGFR-TKI clinical efficacy in patients with advanced NSCLC acquired resistance accurately,improve patients objective response rate and median progression free survival time,reduce the side effects of chemotherapy,it is worthy of clinical promotion.