培美曲塞或吉西他滨联合卡铂一线治疗老年晚期非小细胞肺癌的疗效和安全性  

Efficacy and safety of pemetrexed or gemcitabine combined with carboplatin as the first-line therapy in elderly patients with advanced non-small cell lung cancer

作　　者：施勋[1] 余新民[1] 张沂平[1] 赵珺[1] 

机构地区：[1]浙江省肿瘤医院肿瘤内科,杭州310022

出　　处：《中华肿瘤杂志》2013年第3期221-224,共4页Chinese Journal of Oncology

摘　　要：目的观察培美曲塞或吉西他滨联合卡铂一线治疗老年晚期非小细胞肺癌（NSCLC）的疗效和安全性。方法≥70岁的Ⅲb期和Ⅳ期老年NSCLC患者70例，按随机数字表法分入培美曲塞联合卡铂（PC）组和吉西他滨联合卡铂（GC）组，每组35例。PC组：培美曲塞500mg／m2第1天静脉滴注，卡铂按曲线下面积（AUC）=5的剂量水平第1天静脉滴注，21d为1个周期。GC组：吉西他滨1000mg／m2第1、8天静脉滴注，卡铂按AUC=5的剂量水平第1天静脉滴注，21d为1个周期。结果PC组完全缓解（CR）0例，部分缓解（PR）10例，有效率为28．6％；GC组CR0例，PR8例，有效率为22．9％。两组患者有效率的差异无统计学意义（r=0．299，P=0．584）。PC组患者的中位生存时间为10．0个月，1、2年生存率分别为48．6％和11．4％；GC组患者的中位生存时间为10．0个月，1、2年生存率分别为45．7％和11．4％。两组患者生存曲线的差异无统计学意义（X2=0．01，P=0．919）。GC组患者Ⅲ-Ⅳ级粒细胞减少、血小板减少、恶心呕吐的发生率均明显高于PC组（均P〈0．05）。肺癌症状量表评分显示，PC组和GC组患者在治疗后的评分均较治疗前改善，且两组差异并无统计学意义（P〉0．05）。结论培美曲塞联合卡铂或吉西他滨联合卡铂对老年晚期NSCLC的疗效相近，但培美曲塞联合卡铂可能更安全。Objective To observe the clinical efficacy and safety of pemetrexed or gemcitabine combined with carboplatin as the first-line therapy in elderly patients with advanced non-small cell lung cancer （NSCLC）. Methods Seventy patients aged 70 years or over with stage Ⅲb-ⅣⅢNSCLC were equally and randomly divided into pemetrexed plus eisplatin group （PC） and gemcitabine plus carboplatin group （GC）. Patients in the PC group received pemetrexed （PEM） 500 mg/m2 on day 1, and earhoplatin （CBP） AUC5 on day 1 for 21-day cycle. Patients in the GC group received gemcitabine 1000 mg/m2 on days 1 and 8, CBP AUC5 on day 1 for a 21-day cycle. Results In the PC and GC groups, CR 0 and 0, PR 10 and 8, response rates 28.6% and 22.9% were observed, respectively. There was no statistically significant difference between the two groups （X2 = 0. 299,P = 0.584）. The 1-year and 2-year survival rates of the PC and GC groups were 48.6% vs. 45.7% and 11.4% vs. 11.4% , respectively, with a median survival of 11.00 and 10.00 months, without a statistically significant difference between the two groups （X2 = 0.01, P =0. 919 ）. Regarding toxieities, the incidences of neutropenia/thrombocytopenia, nausea and vomiting （grade Ⅲ-Ⅳ ） in the GC group were significantly higher than those in the PC group （ P 〈 0. 05 ）. According to the observer scale of lung cancer symptoms, the post-treatment scores improved in both the two groups, and with no significant difference between them （ P 〉 0.05 ）. Conclusions PC and GC show similar efficacy for elderly NSCLC patients, however, the toxicities in PC patients are lower than those in GC patients. Thus, pemetrexed combined with carboplatin is an effective chemotherapeutic regimen for advanced NSCLC in elderly patients.

关 键 词：肺肿瘤 老年人 培美曲塞 吉西他滨 治疗结果 

分 类 号：R734[医药卫生—肿瘤]