培美曲塞联用吉非替尼治疗晚期非小细胞肺癌患者的临床研究

Clinical trial of the pemetrexed and gefitinib in the treatment of the patients with advanced non-small cell lung cancer

目的比较培美曲塞+吉非替尼联用和培美曲塞单用对晚期非小细胞肺癌(NSCLC)患者的治疗效果。方法选取2014年1月至2016年7月本院收治的91例晚期NSCLC患者,其中45例患者采用培美曲塞(静脉滴注培美曲塞500mg·m^-2,每3周给药1次)单药治疗作为培美曲塞组;另外46例患者采用培美曲塞+吉非替尼(在单药治疗基础上,口服吉非替尼0.25 g,1次/天)作为联合组。患者化疗前、化疗4个周期后,以酶联免疫吸附法检测患者血清胸甘激酶-1(TK-1)和鳞状上皮细胞癌抗原(SCC-Ag)水平,观察并分析2组患者的总生存时间、生存率和化疗效果。结果联合组患者的完全缓解率+部分缓解率为63.04%(29例/46例),高于培美曲塞组的42.22%(19例/45例),组间比较差异有统计学意义(P<0.05)。化疗后,联合组和培美曲塞组患者的血清TK-1水平分别为(1.72±0.69),(2.11±0.73)pmol·L^-1;这2组的SCC-Ag水平分别为(0.94±0.42),(1.30±0.66)ng·mL^-1;联合组均显著低于培美曲塞组,组间比较差异均有统计学意义(均P<0.05)。联合组的24个月生存率为32.61%,与培美曲塞组的20.00%比较,差异无统计学意义(P>0.05)。联合组的总生存时间为23.0个月,与培美曲塞组的19.0个月比较,差异有统计学意义(P<0.05)。结论培美曲塞+吉非替尼对晚期NSCLC患者治疗效果好于单用培美曲塞,对于降低血清肿瘤标记物及延长患者生存时间有一定的价值。

Objective To comparison the effect of pemetrexed and gefitinib+pemetrexed in the treatment of patients with advanced non-small cell lung cancer(NSCLC).Methods A total of 91 patients with advanced NSCLC admitted to our hospital from January 2014 to July 2016 were enrolled.Forty-five patients were treated with pemetrex(pemetrexed 500 mg·m^-2 was given intravenously once every 3 weeks)monotherapy as pemetrexed group;forty-six patients were treated with pemetrexed+gefitinib(basis on the monotherapy,oral gefitinib0.25 g,once a day)as joint group.Before chemotherapy and after 4 cycles of chemotherapy,serum levels of thymidine kinase-1(TK-1),cancer antigen(SCC-Ag)were determined by enzyme linked immunosorbent assay.The overall survival time,survival rate,effect chemotherapy were observed and analyzed between the two groups.Results The(complete relief+partial remission)rate of patients in joint group was 63.04%(29 cases/46 cases)higher than 42.22%(19 cases/45 cases)in the pemetrexed group,and the difference was statistically significant(P<0.05).After chemotherapy,serum TK-1 in joint group and pemetrexed group were(1.72±0.69),(2.11±0.73)pmol·L^-1;serum SCC-Ag in the two groups were(0.94±0.42),(1.30±0.66)ng·mL^-1;the joint group was significantly lower than pemetrexed group,the difference of the factors were significantly(all P<0.05).The 24-month survival rate of 32.61%in the joint group was not significantly different from 20.00%in the pemetrexed group(P>0.05).The total survival time in the joint group was 23.0 months longer than the 19.0 months in the pemetrexed group,and the difference was statistically significant(P<0.05).Conclusion Pemetrexed+gefitinib in the treatment of patients with advanced NSCLC because of the use of pemetrexed alone,has a certain value for reducing serum tumor markers and prolonging the survival time of patients.