晚期非小细胞肺癌二线治疗不同方案的疗效及成本效益分析  

Effect and cost-efficacy analysis of the second-line treatment of advanced non-small cell lung cancer

作　　者：张静[1] 刘素勤[2] 张洁[2] 班丽英[2] 周涛[2] 

机构地区：[1]淄博市中心医院肿瘤科,255036 [2]大连医科大学附属第一医院肿瘤科,辽宁大连116011

出　　处：《临床肿瘤学杂志》2012年第10期908-911,共4页Chinese Clinical Oncology

摘　　要：目的评价多西他赛、培美曲塞、厄洛替尼和吉非替尼4种方案二线治疗晚期非小细胞肺癌(NSCLC)的疗效,并进行成本效益分析。方法 160例晚期NSCLC患者按二线治疗方案分为4组,每组40例。4种方案分别为:多西他赛75mg/m2iv.,d1;培美曲塞500mg/m2iv.,d1;厄洛替尼150mg,每日1次;吉非替尼250mg,每日1次。前两组以21天为1周期,共化疗2～6个周期;后两组口服至病情进展或出现无法耐受的不良反应停药。对所有患者进行近期疗效和无进展生存期(PFS)评价,以获得1个单位(1个月)PFS的花费计算4种方案的成本效益比。结果多西他赛组、培美曲塞组、厄洛替尼组、吉非替尼组有效率分别为7.5%、10.0%、20.0%和22.5%(P=0.165);疾病控制率分别为32.5%、50.0%、65.0%和52.5%(P=0.035);中位PFS分别为2.7个月、2.8个月、3.5个月和3.5个月(P=0.677)。4种方案的3～4级不良反应以多西他赛多见。每获得1个单位PFS,4种方案的花费分别为5635.6、10 279.6、20 814.0和17 587.8元;以多西他赛组为参照,培美曲塞组、厄洛替尼组和吉非替尼组的成本-效益比分别为46 434.7、119 729.4和103 171.0元/月。敏感度分析与成本效益分析的结论一致。结论多西他赛、培美曲塞、厄洛替尼和吉非替尼4种二线治疗方案治疗晚期NSCLC的疗效未见差异,多西他赛方案的成本-效益比最优;厄洛替尼或吉非替尼治疗的花费高,但不良反应较轻。Objective To evaluate the effect and cost-efficacy of the second-line treatment of advanced non-small cell lung cancer（NSCLC） by regimens of docetaxel, pemetrexed, erlotinib and gefitinb. Methods A total of 160 patients with advanced NSCLC were assigned to docetaxel, pemetrexed, erlotinib and gefitinb groups （40 cases in each group ）. The dosages of the 4 drugs were doeetaxel 75mg/m^2 d1, pemetrexcd 500mg/m^2 dr, erlotinib 150 mg/d and gefitinb 250mg/d. The former two regimens were given 2-6 cycles（21 days as a cycle）. The later two regimens were given till the disease progressed or intolerant side effect emerged. The ef- fective rate, disease control rate, progress-free survival（PFS） and cost-efficacy ratio were analyzed. Results The effective rate of docetaxel, pemetrexed, erlotinib and gefitinb group was 7.5% , 10.0% , 20. 0% and 22. 5% （ P = 0. 165 ） ; disease control rate was 32.5% , 50. 0%, 65.0% and 52. 5% （P =0. 035） ;median PFS was 2. 7, 2. 8, 3.5 and 3.5months （P =0. 677） ; the cost of per unit （ 1 month） increasing of PFS was 5635.6, 10 279. 6, 20 814. 0 and 17 587. 8 yuan. Taking docetaxel group as control, the cost-efficacy ratio of pemetrexed, erlotinib and gefitinb group was 46 434.7, 119 729. 4 and 103 171.0 yuan/month. The sensitivity analysis supported the results of benefit-cost evaluation. Conclusion Docetaxel, pemetrexed, erlotinib and gefitinb have no statistically significance in the second-line treatment of advanced NSCLC. Docetaxel had better cost-efficacy. Erlotinib and gefitinb have less side effects but the most expensive cost.

关 键 词：非小细胞肺癌 多西他赛 培美曲塞 厄洛替尼 吉非替尼 成本效益分析 

分 类 号：R734.2[医药卫生—肿瘤]