培美曲塞二钠二线治疗晚期非小细胞肺癌近期疗效观察

目的比较单用培美曲塞二钠及多西紫杉醇应用于一线化疗失败的晚期非小细胞肺癌患者的疗效与安全性。方法42例既往一线化疗失败或不能耐受的Ⅳ期非小细胞肺癌患者分别分入培美曲塞二钠和多西紫杉醇组,22例患者接受培美曲塞二钠500 mg/m2治疗,20例患者接受多西紫杉醇75 mg/m2治疗。入选患者至少接受2个周期以上化疗,最多接受6个周期化疗。结果入组的42例患者均可评价疗效。单用培美曲塞二钠组及单用多西紫杉醇组的总有效率分别是13.6%和10.0%（P=0.716）,疾病控制率分别是54.5%和55.0%（P=0.976）。单用培美曲塞二钠组和多西紫杉醇组患者的中位生存时间分别为8.2和8.1个月（P=0.258）,1年生存率分别为27.3%和25.0%（P=0.580）。两组的不良反应主要为骨髓抑制、恶心/呕吐、乏力及脱发。培美曲塞二钠组发生中性粒细胞减少的机率明显低于多西紫杉醇组（Ⅰ-Ⅱ度：31.8%对65.0%,P=0.032;Ⅲ-Ⅳ度：4.5%对30.0%,P=0.027）。结论对于既往一线化疗失败或不能耐受的Ⅳ期非小细胞肺癌患者,单药使用培美曲塞二钠及单药使用多西紫杉醇进行化疗疗效相似,但使用培美曲塞二钠单药不良反应更低，值得临床推广。

Clinical observation of efficacy of pemetrexed as second-line therapy in treatment of patients with advanced non-small-cell lung cancer

Objective To compare the efficacy and safety of pemetrexed and docetaxel in treatment of patients with advanced non-small-cell lung cancer（NSCLC）previously treated with chemotherapy.Methods Forty-two patients with stage-Ⅳ NSCLC who had a performance status 0 to 2 and failed in previous treatment with chemotherapy were assigned to two groups： 22 patients received pemetrexed 500 mg/m2 and 20 patients received docetaxel 75 mg/m2.All eligible patients received 2 cycles of chemotherapy at least and 6 cycles chemotherapy at most. Results Forty-two patients were evaluable for efficacy. Overall response rates were 13. 6% vs 10. 0% （P = 0. 716 ） and disease control rates were 54.5 % vs 55.0% （P = 0. 976 ）in pemetrexed and docetaxel groups respectively. The median survival time was 8.2 vs 8.1 months（ P = 0. 258 ） in pemetrexed and docetaxel groups respectively. The t-year survival rates in pemetrexed and docetaxel groups were 27.3% vs 25.0% （ P = 0. 580 ） respectively. The principal toxic reactions were myelosuppression, nausea/vomiting, fatigue and alopecia. Patients receiving pemetrexed were less likely to have neutropenia（grade 1 to 2： 31.8% vs 65.0% , P =0. 032; grade 3 to 4： 4. 5% vs 30. 0%, P =0. 027）compared with patients receiving docetaxel. Conclusion Treatment with pemetrexed resulted in clinically equivalent efficacy, but with significantly fewer side effects compared with docetaxel in the second-line treatment of patients with advanced NSCLC and should be recommended when available.