陈守华 姚卫东 顾红兵

[摘要] 目的：比较培美曲塞（PEM）联合顺铂（DDP）与多西他赛（DOC）联合DDP治疗晚期肺腺癌的临床疗效及毒性反应。方法：将44例晚期肺腺癌（ⅢB～Ⅳ期）患者随机分为培美曲塞加顺铂组（PC组）和多西他赛加顺铂组（DC组），每组22例。PC组，PEM 500 mg/m2+生理盐水100 ml，静滴10～30 min，第1天；DC组，DOC 75 mg/m2+生理盐水250 ml静滴1 h，第1天。两组DDP均为25 mg/m2，第1～3天给药；每21天重复。治疗2个周期后评价疗效，治疗期间观察不良反应。结果：PC组总有效率为45.5%，中位无进展时间5.5个月；DC组总有效率为40.9%，中位无进展时间4.8个月。两组比较差异均无统计学意义（均P＞0.05）。PC组骨髓抑制、胃肠道反应、肝肾功能损害等毒性反应显著低于DC组（均P＜0.05）。结论：培美曲塞联合顺铂治疗晚期非小细胞肺癌的疗效与多西他赛加顺铂的疗效相当，但毒性反应明显减少，可作为晚期肺腺癌患者的一线治疗用药。

[关键词] 肺腺癌；一线化疗；培美曲塞；多西他赛；顺铂

[中图分类号] R734.2[文献标识码]A [文章编号]1673-7210（2011）11（c）-078-03

Observation of curative effect on Pemetrexed or Docetaxel plus Cisplatin in the first-line treatment of patients with lung adenocarcinoma

CHEN Shouhua, YAO Weidong, GU Hongbing

Department of Medical Oncology, Nantong Tumor Hospital, Jiangsu Province, Nantong 226361, China

[Abstract] Objective: To observe the efficacy and toxicity of Pemetrexed or Docetaxel plus Cisplatin in the first-line therapy of patients with lung adenocarcinoma. Methods: 44 patients with late stage lung adenocarcinoma (the stage of ⅢB-Ⅳ) were enrolled into this study. These patients were divided into PC group (Pemetrexed plus Cisplatin) and DC group (Docetaxel plus Cisplatin), with 22 cases in each group. group PC: Pemetrexed 500 mg/m2 plus normal saline 100 ml, 10-30 min ivgtt, in the first day; DC group: Docetaxel 75 mg/m2 plus normal saline 250 ml, 1 h ivgtt, in the first day. Both groups were given Cisplatin 25 mg/m2 ivgtt, d1-3. The treatment would be repeated every 21 days. The efficacy and toxicity of patients after receiving two cycles will be evaluated. Results: The overall response rate was 45.5% in PC group and 40.9% in DC group. The average time for progressive disease was 5.5 months in PC group and 4.8 months in DC group. No significant statistical differences in the overall response rates and the average time for progressive were found between the two groups (P＞0.05). The side effects of myelosuppression, gastrointestinal disorders, toxity of liver and kidney and hematologic toxicities in PC group were less and slighter than DC group (P＜0.05). Conclusion: Pemetrexed plus Cisplatin has the same activity as Docetaxel plus Cisplatin in the treatment of patients with lung adenocarcinoma, but the toxicities are more less and they can be the first-line therapy for patients with lung adenocarcinoma.

[Key words] Lung adenocarcinoma; First-line therapy; Pemetrexe; Docetaxel; Cisplatin

肺癌是当今世界最常见的恶性肿瘤之一，其中非小细胞肺癌（NSCLC）约占肺癌的80%，其中约1/2为腺癌，70%～80%的肺癌患者确诊时已为晚期（ⅢB～Ⅳ期），丧失手术机会，当前晚期NSCLC的治疗仍然以化疗为首选。培美曲塞（PEM）是一种结构上含有核心为吡咯嘧啶基团的抗叶酸制剂，通过破坏细胞内叶酸依赖性的正常代谢过程，抑制细胞复制，从而抑制肿瘤的生长。临床上培美曲塞一直作为非小细胞癌的二线药物，目前国外有将培美曲赛用于非鳞癌NSCLC一线治疗的报道[1]，但国内尚未广泛应用，相关报道也较少。本文笔者采用……