培美曲塞联合奥沙利铂与吉西他滨联合奥沙利铂治疗老年晚期肺腺癌

目的 探讨培美曲塞联合奥沙利铂与吉西他滨联合奥沙利铂治疗老年晚期肺腺癌的疗效及毒副反应.方法 将经病理组织学或细胞学确诊为晚期肺腺癌的老年患者（年龄≥70岁）64例作为研究对象,按所接受的方案分为培美曲塞联合奥沙利铂组及吉西他滨联合奥沙利铂组,其中培美曲塞500mg/m2,第1天静脉滴注30min;培美曲塞用药前1周始,补充维生素B12l000μg,叶酸400μg/d,于输注培美曲塞的前日、当日、次日口服地塞米松4mg,每日2次;吉西他滨1000mg/m2,第1、8天静脉滴注30min;奥沙利铂65mg/m2,第1、8天静脉滴注2h;21d为1个周期,每例患者至少治疗2个周期以上,按照RECIST标准评价化疗疗效和毒性.结果 PO组32例,完全缓解0例,部分缓解16例,稳定13例,总有效率为50.0%;GO组32例,完全缓解0例,部分缓解14例,稳定13例,总有效率为43.8%,PO组与GO组比较差异无统计学意义（P ＞0.05）.PO组的骨髓抑制、消化道反应、肾功能损害、脱发的发生率明显低于GO组,差异有统计学意义（P ＜0.05）.结论 PO方案与GO方案治疗老年晚期肺腺癌的疗效相似,但PO方案较GO方案的不良反应轻,老年患者更容易耐受,是老年晚期肺腺癌较理想的化疗方法.

Study of pemetrexed or gemcitabine in combination with oxaliplatin in treatment of elderly patients with advanced adenocarcinoma of lung

Objective To observe and compare the efficacy and toxicity of pemetrexed or gemcitabine in combination with oxaliplation in the treatment of elder patients with advanced adenocarcinoma of lung. Methods 64 elderly patients（age I〉 70） with advanced adenocarcinoma of lung diagnosed pathologically were divided into PO or GO（pemetrexed 500 mg/m2 iv drip for 30minutes on dayl or gemcitabine 1 000 mg/m2 iv drip for 30minutes on dayl,8 and oxaliplation 65 mg/m2 iv drip for 2 hours on dayl,8）.Each patients was given 2 cycles at least. The chemotherapy was repeated every 21 days and the efficacy and toxicity were then evaluated. Results 32 cases could be evaluated in PO group and 32 cases could be evaluated in GO group.In PO group,the overall response rate was 50.0% and that was 43.8% in GO group, marrow depression,gastrointestinal reaction,renal toxicity and alopecie were more pronounced in GO group （P 〈 0.05）. Conclusion The efficacy was similar to PO project and GO project in the treatment of elderly patients with advanced adenocarcinoma of lung marrow depression, gastrointestinal reaction,renal toxicity and alopecie were more pronounced in GO group. In this study,PO project would be better tolerated than GO project in the treatment of elderly patients with advanced adenocarcinoma of lung. So the PO project might be ideal in the treatment of elderly patients with advanced adenocarcinoma of tung.