培美曲塞联合顺铂二线治疗进展期胃癌的疗效分析  

Pemetrexed plus cisplatin as second-line treatment for patients with advanced gastric cancer

作　　者：闫洁[1] 贾永旭[1] 秦艳茹[1] 

机构地区：[1]郑州大学第一附属医院肿瘤科,河南郑州450052

出　　处：《实用肿瘤杂志》2014年第4期371-374,共4页Journal of Practical Oncology

摘　　要：目的观察培美曲塞联合顺铂方案二线治疗进展期胃癌的临床疗效、不良反应及HER-2基因表达情况对其疗效的影响。方法回顾性分析44例采用二线方案化疗的晚期胃癌患者的临床资料:培美曲塞500 mg/m2d1、顺铂75 mg/m2d1,每21天重复1次,≥2周期。分析HER-2表达与其近期疗效、无进展生存时间(PFS)和总生存时间(OS)的关系。结果全组共接受化疗146周期(中位4周期),其中完全缓解0例,部分缓解4例(9.1%),病情稳定22例(50.0%),病情进展18例(40.9%),总有效率(ORR)为10.0%,疾病控制率(DCR)为59.0%。中位PFS为3.6月,中位OS为7.4月。HER-2阳性与阴性表达患者的近期疗效间差异无统计学意义(P>0.05)。不良反应中最常见的为血液学毒性,Ⅲ～Ⅳ级血红蛋白减少、中性粒细胞减少、血小板减少发生率分别为11.4%、20.5%、2.3%;非血液学毒性反应较轻,Ⅰ～Ⅱ级恶心、呕吐发生率为52.3%,Ⅰ～Ⅱ级脱发、皮疹发生率为43.2%。结论培美曲塞联合顺铂治疗晚期胃癌有明确疗效,且不良反应较小,患者可耐受。HER-2表达情况对其近期疗效无确切影响。Objective To evaluate the clinical efficacy and safety of pemetrexed combined with cisplatin as secondline treatment for patients with advanced gastric cancer and its association with HER-2 expression. Methods The clinical data of 44 patients with advanced gastric cancer who received pemetrexed plus cisplatin as second-line treatment were analyzed retrospectively. Pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 were given at d1 with 21 d as one cycle for at least two cycles. The correlation of HER-2 expression with short-term efficacy,progression-free survival time（ PFS） and overall survival time（ OS） of patients was analyzed. Results A total of 146 cycles of chemotherapy were given to 44 patients with a median of 4 cycles. CR was achieved in 0 cases（ 0%）,PR in 4 cases（ 9. 1%）,SD in 22 cases（ 50. 0%）,and PD in 18cases（ 40. 9%）. Overall response rate（ ORR） was 10. 0%; disease control rate（ DCR） was 59. 0%; the median PFS was 3. 6 months and the median OS was 7. 4 months. There were no significant differences in short-term efficacy between patients with positive HER-2 and negative HER-2 expression（ P 〉0. 05）. For hematological toxicity,the adverse reaction rate was 11. 4%,20. 5%,2. 3% for Ⅲ ～ Ⅳ grade hemoglobin decrease,neutropenia and thrombocytopenia,respectively;For non-hematologic toxicity,the incidence rate of mild Ⅰ ～ Ⅱ grade nausea and vomiting was 52. 3% and that of Ⅰ ～ Ⅱrash and alopecia was 43. 2%. Conclusion Pemetrexed in combination with cisplatin is effective and safe for patients with advanced gastric cancer and the efficacy is not correlated with HER-2 expression.

关 键 词：胃肿瘤 药物疗法 谷氨酸盐类 鸟嘌呤 类似物和衍生物 鸟嘌呤 投药和剂量 顺铂 投药和剂量 抗肿瘤联合化疗方案 治疗应用 基因 ERBB-2 生存率 回顾性研究 

分 类 号：R735.2[医药卫生—肿瘤] R730.53[医药卫生—临床医学]