培美曲塞联合卡铂治疗老年晚期非小细胞肺癌的临床观察

目的观察培美曲塞（Pemetrexed，PEM）联合卡铂（carboplatin，CBP）治疗老年晚期非小细胞肺癌（NSCLC）的有效性和毒副反应。方法49例老年晚期NSCLC患者接受PEM（500mg／m^2）联合CBP（AUC=5）方案化疗。21d为1个疗程，每例患者至少接受2个疗程。结果所有患者均可评价疗效，完全缓解（cR）0例，部分缓解（PR）23例，稳定（sD）21例，进展（PD）5例。总有效率（RR）为46．9％（23／49），NSCLC患者IIIB期有效率68．2％，明显高于Ⅳ期29．6％（X^2=3．879，P〈0．05），疾病进展时间（TTP）5．3个月，中位生存期（MST）11．2个月（3～21个月），1年生存率为54．3％。毒副反应主要有骨髓抑制、恶心呕吐、腹泻、肝功能受损及粒缺所致发热等。49例中，白细胞减少23例（46．9％）明显高于恶心11例（22．4％）、呕吐5例（10．0％）、肝功能异常4例（8．o％）。发热1例（2．0％）（f=3．879，P〈0．05；X^2=8．451、8．778、9．123、9．741，均P〈0．01）。结论培美曲塞联合卡铂方案可作为老年晚期NSCLC有效的一线化疗方案。

Clinical research of pemetrexed combination with carboplatin as the therapy in advanced non-small cell lung cancer of senium

Objective To evaluate the curative effect and toxic reaction of pemetrexed combination with carboplatin as the therapy in advanced non-small cell lung cancer(NSCLC) of senium.Methods A total of 49 chemotherapy naive patients with ⅢB or Ⅳ NSCLC were enrolled in this study.Pemetrexed was given at a dose of 500mg/m2.Carboplatin dosed to an area under the time-concentration curve( AUC ) of 5.The chemotherapy was repeated every 21 days.Each patient was given at least 2 cycles.Results The curative effects of all the patients were evaluated.Among the 49 patients, the symptoms of 23 had been partially response ,21 stabilized and 5 progressed.The total effective rate was 46.9% ( 23/49 ).The efficiency of 68.2% in NSCLC with ⅢB phase were significantly higher than,29.6% in NSCLC with IV phase( X2 = 3.879, P < 0.05 ), Median time to progression (TIP) was 5.3 months.Median survival duration was 11.2 months( 3～ 21 months), and one year survival rate was 54.3%.The major toxicity included neutropenia, nausea, vomiting and diarrhea, impaired liver function, febrile neutropenia, etc.The severity of these side effect was in grade Ⅰ-Ⅱ and well tolerated.Among 49 cases,23 cases of leukopenia(46.9% ) was significantly higher than that of nausea in 11 cases (22.4%), vomiting in 5 cases ( 10.0% ), abnormal liver function in 4 cases( 8.0% ).Fever in 1 case ( 2.0% ) ( X2 = 3.879, P < 0.05 ; X2 = 8.451,8.778,9.123,9.741, all P < 0.01 ).Conclusion Pemetrexed combination with carboplatin was effective in the first line treatment of advanced non-small cell lung cancer,with mild to moderate side effect and safety in clinical practice.