培美曲塞二线治疗晚期非小细胞肺癌的临床观察

目的观察培美曲塞二线治疗晚期非小细胞肺癌的疗效及毒副反应。方法我院2008年4月～2009年10月收治晚期NSCLC患者20例,均经病理组织学或细胞学确诊ⅢB期5例,Ⅳ期15例。均接受过2个周期以上的含铂方案化疗,肿瘤进展或复发,国产培美曲塞二钠500mg/m2D1,IV,每21天为1周期。持续用药直至肿瘤进展或出现不可耐受的不良反应。结果ORR为22.2%,DCR为75.0%,中位PFS为6个月,中位OS为10个月。全组患者临床症状均有不同程度的改善,主要表现为咳嗽、胸痛好转,胸闷、气促、乏力减轻和体力状态改善。主要不良反应有骨髓抑制、神经系统毒性、肝肾功能影响、皮疹、脱屑、皮肤搔痒、胃肠道反应如恶心、呕吐、腹泻、疲劳。不良反应主要为Ⅰ、Ⅱ级,无1例患者因出现不可耐受的不良反应而退出治疗,亦未出现药物相关死亡。结论PFS和OS不低于一线含铂化疗方案,中位总生存期甚至高于一线含铂化疗方案,且主要毒副反应耐受性较好,且可作为晚期非小细胞肺癌二线治疗首选。

Pemetrexed second-line treatment of advanced non-small cell lung cancer

Objective To observe the pemetrexed second-line treatment of advanced non-small cell lung cancer,the efficacy and toxicity.Methods 20 patients with advanced NSCLC were characterized by histopathology or cytology Ⅲ B 5 cases,and stage Ⅳ 15 cases.All had received two cycles of platinum-containing chemotherapy with tumor progression or recurrence.Pemetrexed disodium 500 mg/m2 D1,IV,every 21 days for a cycle was administered until tumor progression or the appearance of untolerable side effects.Results ORR was 22.2%,DCR 75.0%,median PFS 6 months and median OS 10 months. The symptoms of the whole group improved to some degree,mainly manifested as improved cough,chest pain,chest tightness,shortness of breath and fatigue physical condition. The main adverse reactions were bone marrow suppression,nervous system toxicity,liver and kidney function,rash,scaling,itchy skin,gastrointestinal reactions such as nausea,vomiting,diarrhea and fatigue. Adverse reactions were mainly Ⅰ or Ⅱ grade,with no patient withdrawing from the therapy,or occurence of drug-related death.Conclusion PFS and OS are by no means in ferior to first-line platinum-containing chemotherapy regimens.The median overall survival is even higher than the first-line platinum-containing chemotherapy regimens.The main side effects are well tolerated,and can be used as the first choice in the advanced non-small cell lung cancer second-line treatment.