培美曲塞在晚期非小细胞肺癌患者中再使用的临床疗效分析  

Clinical efficacy analysis on reuse of pemetrexed in patients with advanced non-small cell lung cancer

作　　者：姜金[1] 杨芝萍[1] 李金瑞[1] 范耀华[1] 郑加莲[1] 

机构地区：[1]浙江省嘉兴市第一医院肿瘤科,浙江嘉兴314000

出　　处：《中国现代医生》2016年第11期72-75,F0003,共5页China Modern Doctor

基　　金：浙江省科技计划项目(2013C33107);浙江省嘉兴市医学重点学科(04-F-14)

摘　　要：目的探讨在晚期非小细胞肺癌患者中既往使用过基于培美曲塞的含铂两药方案失败后再次使用培美曲塞治疗的临床疗效和安全性。方法回顾性分析2008年1月-2014年12月在本院就诊的晚期非小细胞肺癌患者的临床数据。所有患者在一线治疗中均选择培美曲塞联合铂类方案化疗并在后续治疗中再次使用培美曲塞方案化疗。采用Kaplan—Meier法进行生存分析。结果共32例患者纳入本研究。12例患者在四线治疗中应用的化疗方案为培美曲塞，20例患者在四线以后应用化疗方案为培美曲塞。2例患者在培美曲塞再使用过程中获得局部缓解，11例患者疗效稳定，19例患者肿瘤进展。客观有效率和疾病控制率分别为6．3％和40．6％。32例患者的中位无进展生存期为1-4个月（95％CI，0．8-2．6）。一线培美曲塞方案化疗过程中无进展生存期〉6个月的患者采用培美曲塞再使用的无进展生存期为2．6个月，而一线无进展生存期≤6个月的患者采用培美曲塞再使用的无进展生存期为1．1个月（P=0．029）。培美曲塞再次使用的不良反应可以耐受。结论在晚期非小细胞肺癌患者既往采用基于培美曲塞方案化疗失败后再次使用培美曲塞有一定的临床疗效，特别是对于既往培美曲塞方案化疗后无进展生存期较长的患者疗效较好。Objective To discuss the clinical efficacy and safety of reusing pemetrexed in patients with advanced non- small cell lung cancer （NSCLC） who were previously treated by pemetrexed-based and platinum-containing two-drug therapy but failed. Methods Clinical data of patients with advanced NSCLC treated in our hospital from January 2008 to December 2014 were reviewed. All the patients were given pemetrexed combined with platinum drugs for first-line chemotherapy and pemetrexed was chosen again for sequential treatment. Kaplan-Meier method was used for survival analysis. Results 32 patients were enrolled, of which 12 were treated by pemetrexed in fourth-line chemotherapy, and 20 were treated by pemetrexed after fourth-line. Partial response was observed in 2 patients during reuse of peme- trexed, stable efficacy was observed in 11 patients, and tumor progression was observed in 19 patients. The objective response rate was 6.3% and the disease control rate was 40.6%. The median progression free survival of 32 patients was 1.4 months（95% CI, 0.8-2.6）. For patients with progression free survival over 6 months during first-line pemetrexed chemotherapy, the progression free survival was 2.6 months when reusing pemetrexed, while for patients with progression free survival no longer than 6 months during first-line pemetrexed chemotherapy, the progression free survival was 1.1 months when reusing pemetrexed （P=0.029）. The adverse reaction of pemetrexed reuse is tolerable. Conclusion Reuse of pemetrexed has a certain clinical efficacy in patients with advanced NSCLC who were previously treated by pemetrexed-based chemotherapy but failed, especially in those with relatively long progression free survival after previous pemetrexed chemotherapy.

关 键 词：非小细胞肺癌 培美曲塞 再使用 疗效 

分 类 号：R734.2[医药卫生—肿瘤]