培美曲塞单药或联合铂类三线及以上治疗晚期非鳞型非小细胞肺癌的临床观察

背景与目的培美曲塞联合铂类或单药在晚期非小细胞肺癌一、二线治疗中的疗效已得到验证,但其在三线及以上治疗中的地位还不明确。本文旨在观察培美曲塞单药或联合铂类三线及以上治疗晚期非鳞型非小细胞肺癌的临床疗效及安全性。方法 46例多线治疗失败的晚期非鳞型非小细胞肺癌患者接受培美曲塞单药或联合铂类药物治疗。结果 46例晚期非鳞型非小细胞肺癌患者中部分缓解7例,疾病稳定20例,疾病进展19例,客观缓解率为15.2%,疾病控制率为58.7%,中位无疾病进展时间为3.0个月。分析显示培美曲塞联合卡铂及顺铂较培美曲塞单药治疗的疾病控制率明显增高(P=0.043)。常见的不良反应主要有恶心、呕吐及骨髓抑制。结论应用培美曲塞单药或联合铂类治疗多线治疗失败的晚期非鳞型非小细胞肺癌患者仍可使其临床获益,且毒副反应可耐受。

Clinical Investigation of Efficacy of Third-line and Beyond Pemetrexed Treatment in Advanced Non-squamous Non-small Cell Lung Cancer

Background and objective Pemetrexed in combination with platinum or a single-agent has been approved for the first- and second-line treatment of non-small cell lung cancer(NSCLC).However,the role of pemetrexed therapy in the third-line and beyond treatment of NSCLC has yet to be generally accepted.The present retrospective study reports the efficacy and safety of pemetrexed in the third-line and beyond treatment of advanced non-squamous NSCLC. Methods A total of 46 patients with advanced non-squamous NSCLC received a combination of pemetrexed plus platinum or a single-agent after multi-line treatment failed to yield positive results.Results Of the 46 patients who participated in the study,7 achieved partial responses,20 reached a stage of stable disease,and 19 reached a stage of progressive disease.The overall object response rate was 15.2%and the disease control rate(DCR) was 58.7%.The median progression-free survival time was 3.0 months.Pemetrexed in combination with platinum yielded a higher DCR than the pemetrexed plus single-agent treatment (P=0.043).Common adverse events included nausea,vomiting and myelosuppression.Conclusion Administration of pemetrexed after failure of multi-line treatment is clinically beneficial to patients with advanced non-squamous NSCLC.The toxic effects of the treatment appear to be tolerable.