培美曲塞联合顺铂二线治疗进展期胃癌的疗效分析

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/m2dl、顺铂75 mg/m2 dl,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.

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

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.