培美曲塞或多西他赛联合卡铂治疗吉非替尼耐药的晚期肺腺癌患者的疗效

Clinical efficacy of pemetrexed plus carboplatin versus docetaxel plus carboplatin in treatment of advanced lung adenocarcinoma patients with gefitinib resistance

目的:观察培美曲塞或多西他赛联合卡铂治疗吉非替尼耐药的晚期肺腺癌患者的疗效和安全性。方法:56例吉非替尼耐药的晚期(Ⅲ~Ⅳ期)肺腺癌患者中,28例采用培美曲塞联合卡铂化疗(培美曲塞组),28例采用多西他赛联合卡铂化疗(多西他赛组),21 d为1个化疗周期,2个化疗周期后评估疗效及不良反应,并进行长期随访。结果:2组近期疗效相比,差异无统计学意义(P=0.159);2组的治疗有效率、疾病控制率、无进展生存期及总生存时间相比,差异均无统计学意义(P>0.05)。培美曲塞组Ⅲ、Ⅳ度白细胞减少、中性粒细胞减少、血小板减少、恶心呕吐的发生率均较多西他赛组下降(P<0.05)。结论:培美曲塞联合卡铂与多西他赛联合卡铂治疗吉非替尼耐药的晚期肺腺癌患者疗效相当,但培美曲塞联合卡铂方案的不良反应更轻,更值得临床推广。

Aim:To analyze the clinical efficacy of pemetrexed plus carboplatin versus docetaxel plus carboplatin in subsequent treatment of advanced lung adenocarcinoma patients with acquired resistance to gefitinib.Methods:A retrospective study was conducted on 56 advanced lung adenocarcinoma patients with acquired resistance to gefitinib.Among the 56 patients,28 patients received docetaxel in combination with carboplatin(docetaxel group)while the remaining 28 patients received pemetrexed in combination with carboplatin(pemetrexed group),both with a 21 day treatment cycle.The short-term and long-term efficacy,and adverse reactions were compared between the 2 groups after 2 treatment cycles.Results:The short-term efficacy between the 2 groups had no significant difference(P=0.159).There was no significant difference in the ratio of RR,DCR,PFS or OS between the 2 groups(P>0.05).The incidence rates of severe leukopenia,neutropenia,thrombocytopenia,nausea and vomiting of patients in pemetrexed group were lower than those in the docetaxel group(P<0.05).Conclusion:The curative effects of pemetrexed with carboplatin and docetaxel with carboplatin are equal in the treatment of advanced lung adenocarcinoma patients with acquired resistance to gefitinib,but pemetrexed therapy had higher safety with milder adverse reactions,so it is worthy to be popularized in clinic.