培美曲塞二钠单药治疗老年非小细胞肺癌21例

目的]观察培美曲塞二钠单药治疗老年非小细胞肺癌的临床疗效和不良反应。方法]经病理学或细胞学确诊的老年（65～80岁）晚期ⅢA～Ⅳ期非小细胞肺癌43例,21例患者接受培美曲塞二钠500mg/m2治疗,静脉滴注,d1;22例患者接受吉西他滨1000mg/m2治疗,d1、8、15。21d为1个周期,接受2个周期以上化疗,每2个周期评估疗效、不良反应。结果]培美曲塞二钠组和吉西他滨组临床获益率分别是57.14%和59.09%（P=0.897）,中位生存期分别是9.5个月和8.9个月（P=0.813）,1年生存率分别是28.6%和27.3%（P=0.9244）。两组主要的不良反应是骨髓抑制和胃肠道反应,其中培美曲塞二钠组中性粒细胞降低发生率明显低于吉西他滨组（Ⅰ～Ⅱ度：19.05%vs59.09%,P=0.0073,Ⅲ～Ⅳ度：9.52%vs27.27%,P=0.0261）;培美曲塞二钠组胃肠道反应发生率也明显低于吉西他滨组（Ⅰ～Ⅱ度：14.29%vs59.09%,P=0.0017;Ⅲ～Ⅳ度：4.76%vs40.91%,P=0.0050）。结论]培美曲塞二钠和吉西他滨单药治疗老年非小细胞肺癌疗效均较好,但培美曲塞二钠不良反应低于吉西他滨。

Chemotherapy with Pemetrexed Alone in the Treatment for 21 Elderly Cases with Non-small Cell Lung Cancer

Purpose] To investigate the response and side effect of pemetrexed alone in the treatment for elderly patients with non-small cell lung cancer (NSCLC). Methods] Forty-three elderly cases with NSCLC stage Ⅲ A ～ Ⅳ confirmed by pathology or cytology were divided into permetrexed group (n=21) and gemcitabine group (n=22). Patients in pemetrexed group received pemetrexed 500mg/m 2 , iv drip,d 1 ; patients in gemcitabine group received gemcitabine1000 mg/ m 2 , iv drip,d 1,8,15 . Every 21 days as a cycle. All patients received >2 cycles chemotherapy, and the response and side effect were evaluated every 2 cycles. Results] The clinical benefit rate in pemetrexed group and gemcitabine group was 57.14% and 59.09% (P =0.897) respectively.The median survival time was 9.5 and 8.9 months (P=0.813) respectively. The 1-year survival rate was 28.6% and 27.3% (P =0.9244) respectively. The main side effects were myelosuppression and gastrointestinal toxicity. The neutropenia rate in pemetrexed group was significantly less than that in gemcitabine group (gradeⅠ～Ⅱ: 19.05% vs 59.09% ,P=0.0073; grade Ⅲ～Ⅳ:9.52% vs 27.2%, P =0.0261). The gastrointestinal toxicity in pemetrexed group was significantly less than that in gemcitabine group (grade Ⅰ～Ⅱ: 14.29% vs 59.01%, P=0.0017;grade Ⅲ～Ⅳ:4.76% vs 40.91% , P=0.0050). Conclusion] Chemotherapy with pemetrexed or gemcitabine for elderly patients with advanced NSCLC is effective, but the side effect of pemetrexed is lower than that of gemcitabine.