肺腺癌患者培美曲塞二线化疗时维生素支持治疗的临床疗效分析  

Clinical efficacy of vitamin support in lung adenocarcinoma patients treated with pemetrexed second- line chemotherapy

作　　者：曾晓媛[1] 周承志[2] 欧阳铭[2] 秦茵茵[2] 杨红忠[1] 彭毅强[1] 刘胜岗[1] 

机构地区：[1]长沙市中心医院呼吸内科,410011 [2]广州医科大学附属第一医院广州呼吸疾病研究所

出　　处：《中华肿瘤杂志》2015年第11期868-872,共5页Chinese Journal of Oncology

基　　金：十二五国家科技支撑计划课题（2013BA109809）

摘　　要：目的分析肺腺癌患者培美曲塞二线化疗时维生素支持治疗的临床疗效和毒副反应。方法2010年8月至2013年8月住院治疗的Ⅲb～Ⅳ期的经组织学和（或）细胞学病理诊断的283例肺腺癌，均为EGFR突变阴性，采用培美曲塞二线化疗。按随机数字表分为改良组（142例）和传统组（141例）。传统组患者采用培美曲塞首次化疗前7d开始口服叶酸400μg，1次／d，直至培美曲塞末次给药后21d，并且在培美曲塞首次给药前7d肌肉注射维生素B121000μg，此后每3个周期注射1次。改良组患者采用培美曲塞首次化疗前1d开始口服叶酸400μg，1次／d，直至培美曲塞末次给药后21d，并且在培美曲塞首次给药前1d肌肉注射维生素B，：500μg，此后每周期前1d注射1次。结果改良组和传统组患者的平均化疗周期均为4个周期。改良组患者中，完全缓解（CR）2例，部分缓解（PR）28例，疾病稳定（SD）21例，疾病进展（PD）91例，有效率为21．1％。传统组患者中，CR1例，PR27例，SD23例，PD90例，有效率为19．9％。改良组和传统组患者的中位无进展生存时间分别为3．8和4．2个月，差异无统计学意义（P=0．143）。两组患者的化疗毒副反应均较轻微，差异均无统计学意义（均P〉0．05），其中两组患者最常见的血液系统毒副反应为白细胞减少和嗜中性粒细胞减少，最常见的非血液系统毒副反应为恶心和呕吐。两组患者最常见的Ⅲ-Ⅳ级毒副反应为白细胞减少和嗜中性粒细胞减少，差异无统计学意义（P〉0．05）。多因素分析显示，肺腺癌患者年龄为发生Ⅲ～Ⅳ级化疗毒副反应的独立因素（P〈0．05），而性别、功能状态评分和基础血液系统状况与Ⅲ～Ⅳ级化疗毒副反应的发生均无关（均P〉0．05）。结论与传统方案比较，培美曲塞化疗前的维生素支持治疗改良方案在保证疗效、使用方便的同时，Objective To analyze the clinical efficacy and toxicity of vitamin support in lung adenocarcinoma patients treated with pemetrexed second-line chemotherapy. Methods Two hundred and eighty-three patients with stage 3/4 lung adenocarcinoma treated at our hospital from August 2010 to August 2013 were included in this study. The lung adenoearcinomas in all the 283 patients were confirmed by pathology or cytology, all were EGFR-negative, and all patients received pemetrexed second line chemotherapy. The 283 patients were randomly divided into two groups： the improved treatment group （ 142 cases） and the conventional treatment group （141 cases）. The patients of conventional treatment group received 400 μg folic acid per os daily for 7 days before the first dose of pemetrexed, and continued until 21 days after the last dose of pemetrexed. Besides, they received 1 000 μg vitamin B12 injection at 7 days before the first dose of pemetrexed, and once per cycle of pemetrexed for 3 cycles after the last dose of pemetrexed. The patients of the improved treatment group took 400 p,g folie acid daily per os from the day before the first dose to 21 days after the last dose of pemetrexed. They also received 500 μg vitamin B12 by injection one day before the first dose, and one day before each therapy cycle of pemetrexed therapy. Results The mean number of cycles of pemetrexed chemotherapy was 4 in both groups. In the 142 patients of improved treatment group, complete response （CR） was observed in two cases, partial remission （PR） in 28, stable disease （SD） in 21, and progressive disease （PD） in 91 cases, with a total effective rate of 21.1%. While in the conventional treatment group, CR was observed in one case, PR in 27 cases, SD in 23 cases, and PD in 90 cases, with a total effective rate of 19.9%. The median progression-free survival （PFS） was 3.8 months in the improved treatment group and 4.2 months in the conventional treatment group （P= 0.143 ）. The toxicity of chemotherapy was mild in

关 键 词：肺肿瘤 药物疗法 治疗结果 培美曲塞 叶酸 维生素B12 

分 类 号：R734.2[医药卫生—肿瘤]