复治晚期非小细胞肺癌EGFR-TKI治疗失败后培美曲塞与多西他赛挽救性化疗的疗效比较  

Comparison of the efficacy of pemetrexed and docetaxel as the salvage chemotherapy in patients with retreatment of advanced non-small cell lung cancer after the failure of EGFR-TKI

作　　者：林宝钗[1,2] 宋正波[3] 邵岚[3] 胡林[3] 凌志强[2] 洪卫[3] 娄广媛[3] 张沂平[1] 

机构地区：[1]浙江中医药大学第二临床医学院,310053 [2]浙江省胸部肿瘤诊治技术研究重点实验室,310022 [3]浙江省肿瘤医院化疗中心,杭州310022

出　　处：《临床肿瘤学杂志》2012年第7期592-596,共5页Chinese Clinical Oncology

基　　金：浙江省医药卫生科学研究基金资助项目(2010KYA036);吴阶平医学基金资助项目(320.6750.11059和320.6750.11091)

摘　　要：目的比较复治晚期非小细胞肺癌(NSCLC)表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)治疗失败后用培美曲塞或多西他赛挽救性化疗的疗效及毒副反应。方法 120例复治晚期NSCLC患者于EGFR-TKI治疗失败后分别接受培美曲塞(500mg/m2,d1)或多西他赛(75mg/m2,d1)的挽救性化疗,均21天为1周期。记录并比较两者的疗效和预后。结果培美曲塞组和多西他赛组的有效率(RR)分别为13.4%和5.3%(P=0.307),疾病控制率(DCR)分别为58.5%和42.1%(P=0.093),中位无进展生存期(PFS)分别为2.83个月和2.10个月(P=0.862),中位总生存期(OS)分别为8.40个月和9.10个月(P=0.527)。EGFR-TKI治疗有效和挽救性化疗前行为状态评分(PS)≤1者的中位PFS较长。培美曲塞组1～4级中性粒细胞减少的发生率低于多西他赛组,分别为41.5%和65.8%(P=0.013)。在非血液学毒性方面两组差异均无统计学意义(P>0.05)。结论复治晚期NSCLC TKI治疗失败后用培美曲塞或多西他赛挽救性化疗,部分患者仍可以获益,两组疗效相当,且大部分患者能够耐受化疗的毒副反应。对于EGFR-TKI治疗有效、挽救性化疗前PS评分较好的患者,有可能从挽救性化疗中获益更大。Objective To compare the efficacy and toxicities of pemetrexed or docetaxel as the salvage chemotherapy in patients with retreatment of advanced non-small cell lung cancer（NSCLC） after the failure of epidermal growth factor receptor-tyrosine kinase inhibitor（EGFR-TKI）.Methods In this study,we retrospectively reviewed 120 cases with retreatment of advanced NSCLC patients in our hospital who were given pemetrexed（500mg/m2 d1） or docetaxel（75mg/m2 d1） as the salvage chemotherapy after the failure of EGFR-TKI.Twenty-one days was a cycle for the two regimens.Results The pemetrexed group was similar to the docetaxel group in objective response rate（13.4% vs.5.3%,P=0.307）,the disease control rate（58.5% vs.42.1%,P=0.093）,the median progression-free survival（2.83 months vs.2.10 months,P=0.862）,and the median overall survival（8.40 months vs.9.10 months,P=0.527）.The median PFS was longer in the patients whose disease could be controlled by EGFR-TKI and who had performance status（PS）≤1（P〈0.05）.The pemetrexed group was lower than the docetaxel group in 1-4 degree neutropenia inhibition（41.5% vs.65.8%,P=0.013）.The non-hematology toxicities did not have significantly differences between the two groups（P〉0.05）.Conclusion A part of patients with retreatment of advanced NSCLC after the failure of EGFR-TKI may still benefit from pemetrexed or docetaxel as the salvage chemotherapy.The efficacy between the two groups does not have significantly difference.The patients whose disease can be controlled by EGFR-TKI or who have PS≤1 are more likely to benefit from the salvage chemotherapy.Most of the patients could accept the adverse reactions of the salvage chemotherapy.

关 键 词：非小细胞肺癌 EGFR-TKI 培美曲塞 多西他赛 

分 类 号：R734.2[医药卫生—肿瘤]