厄洛替尼与培美曲塞治疗晚期非小细胞肺癌效果比较

Efficacy comparison of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer

目的比较厄洛替尼与培美曲塞治疗晚期非小细胞肺癌(NSCLC)患者的疗效及对患者免疫功能的影响.方法回顾性分析海南医学院第一附属医院2014年6月至2018年5月收治的晚期NSCLC患者82例,根据治疗方法不同分为厄洛替尼组(厄洛替尼150 mg/d,餐后2 h口服)和培美曲塞组(培美曲塞500 mg/m^2静脉滴注,21 d为1个周期),每组41例.比较两组患者的临床疗效,采用流式细胞术检测免疫指标.结果培美曲塞组的客观有效率与厄洛替尼组比较[34.2%(14/41)比39.0%(16/41)],差异无统计学意义(χ^2=0.210,P=0.647).两组治疗前后T淋巴细胞亚群水平比较,差异均无统计学意义(均P>0.05).两组治疗后CD3+T细胞、CD4^+T细胞水平、CD4^+/CD8^+比值较治疗前下降,CD8^+T细胞较治疗前上升,差异均有统计学意义(均P<0.05).厄洛替尼组治疗后生命质量调查核心问卷(QLQ-C30)评分高于培美曲塞组[(75.1±13.5)分比(68.9±12.9)分],差异有统计学意义(t=2.158,P=0.017).培美曲塞组不良反应主要以骨髓抑制、胃肠道反应为主,厄洛替尼组主要以皮疹、腹泻为主,不良反应均为Ⅰ~Ⅱ级.两组患者骨髓抑制、胃肠道反应、皮疹及腹泻发生率比较,差异均有统计学意义(均P<0.05).结论厄洛替尼与培美曲塞治疗晚期NSCLC效果相似,均可以调节免疫应答,厄洛替尼在提高患者生命质量方面优势明显.

Objective To compare the efficacy of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer (NSCLC) and its effect on the immunity of patients. Methods A total of 82 patients with NSCLC at the First Affiliated Hospital of Hainan Medical College from June 2014 to May 2018 were retrospectively analyzed. According to the different treatment methods, the patients were divided into erlotinib group (150 mg/d, oral administration, 2 hours after the meal) and pemetrexed group (500 mg/m^2, intravenous drip, 21-day each cycle). There were 41 cases in each group. The clinical effects of the two groups were analyzed. Flow cytometry was used to detect the immune index. Results The objective effective rate in pemetrexed group was lower than that in erlotinib group [34.2% (14/41) vs. 39.0% (16/41), χ^2 = 0.210, P =0.647). There was no significant difference in T lymphocyte subsets between the two groups before and after treatment (both P > 0.05). The values of CD3+ T cells, CD4^+ T cells, CD4^+ / CD8^+ in both groups after the treatment were decreased compared with the values before the treatment;CD8 + T cells was increased after the treatment compared with the value before the treatment (all P < 0.05). Quality of life questionnaire-C30 (QLQ-C30) score in erlotinib group was higher than that in pemetrexed group [(75.1±13.5) vs. (68.9±12.9), t = 2.158, P = 0.017]. Myelosuppression and gastrointestinal reactions were the main adverse events in pemetrexed group;rashes and diarrhoea were the main adverse reactions in erlotinib group. Grade Ⅰ-Ⅱ side effects occurred in both groups. There were statistical differences in the incidence of myelosuppression, gastrointestinal reactions, rashes and diarrhoea of both groups (all P < 0.05). Conclusions The efficacy oferlotinib and pemetrexed in treatment of advanced NSCLC is similar, and both of them could regulate the immune response. Erlotinib has a significant advantage in improving the quality of life.