培美曲塞或紫杉醇联合卡铂一线治疗老年晚期肺腺癌疗效比较

目的 探讨培美曲塞（pemetrexed,PEM）或紫杉醇（taxol,TAL）联合卡铂（carboplatin,CBP）一线治疗老年晚期肺腺癌的临床疗效、毒副反应及生存期.方法 109例年龄≥65岁的老年晚期肺腺癌患者分别应用PC（培美曲塞联合卡铂）方案及TC（紫杉醇联合卡铂）方案化疗.PC组53例,第1天静脉滴注培美曲塞 500 mg/m2;TC组56例,第1天静脉滴注紫杉醇135～175 mg/m2;第2天两组均联合卡铂AUC＝4～5,静脉滴注,21 d为一疗程.每例至少完成2个疗程后评价疗效及毒副反应.结果 两组总有效率分别为33.9%、26.8%;疾病控制率分别为75.4%、69.7%,两组比较差异无统计学意义.两组中位无进展生存期分别为6.5、4.7个月,差异无统计学意义.两组中位生存期分别为16.8、11.8个月,PC组明显高于TC组,差异有统计学意义（P=0.032）.两组1年生存率分别为58.2%及42.3%,差异亦有统计学意义（P=0.013）.两组2年及3年生存率分别为27.3%及24.3%、14.2%及12.5%;两组比较无统计学意义.毒副反应主要为骨髓抑制,TC组在白细胞减少、中性粒细胞减少、脱发等方面发生率明显高于PC组（P＜0.05）.结论 PC方案及TC方案均安全有效,适用于老年晚期肺腺癌化疗,但PC方案生存率高、毒副反应轻,值得进一步研究.

Clinical analysis of pemetrexed or taxol plus carboplatin chemotherapy as first-line treatment for elderly advanced lung adenocarcinoma

Objective To evaluate the efficacy and toxicity of pemetrexed（PEM） or taxol （TAL） plus carboplatin chemotherapy as first-line treatment for elderly advanced lung adenocarcinoma. Methods One hundred and nine patients （ ≥65 years） with advanced lung adenocarcinoma were treated with pemetrexed plus carboplatin （PC） or taxol plus carboplatin （TC） regimen as first-line chemotherapy. Fifty-three patients received PC regimen： pemetrexed 500 mg/m^2 , intravenous drip day 1 ; Fifty-six patients received TC regimen： taxol 135-175 mg/m^2 , intravenous drip day 1 ; carboplatin in both groups： area under the curve 4-5 mg/（ ml · min） , day 2 ; every 3 weeks. Each patient was evaluated on efficacy and toxicity after at least 2 cycles. The general characteristics of patients in the two groups were comparable. Results The response rates in PC group and TC group were 33.9% and 26.8% , whereas the disease control rates were 75.4% and 69.7% , respectively; there was no significant difference between the two groups. Median progres- sion-free survival was 6.5 months in the PC group, and 4.7 months in the TC group, there was also no significant difference. The median overall survival rate in PC group was significantly higher than that in TC group with 16.8 months and l 1.8 months, respectively ; the difference was statistically significant （ P = 0. 032 ）. The 2-year and 3-year survival rates in the two groups were 27.3% and 24.3% , 14.2% and 12.5% , respectively; no significant difference was found between the two groups. The main toxicity was myelo- suppression. I,eucocytopenia, neutropenia and alopecia were more common in the TC group. Conclusions Both the PC regimen and TC regimen are moderately safe and effective for elderly advanced lung adenocarcinoma as first-line treatment. The PC regimen has higher survival rate and tolerated toxicity. It is worth further clinical study.