目的：比较培美曲塞与吉非替尼治疗老年晚期肺腺癌的近期疗效和毒副反应。方法符合入组条件的IV期老年肺腺癌患者50例， EGFR基因均监测到突变，随机分为两组。培美曲塞组采用培美曲塞500 mg/m2，静滴，1次/d，奈达铂25 mg/m2，静滴，1～3次/d，21 d为1个周期，共4～6个周期；吉非替尼组采用口服吉非替尼250 mg，1次/d，直至疾病进展。评估两组的疗效及不良反应。结果培美曲塞组有效率（CR＋PR）32％，疾病控制率64％，吉非替尼组有效率（CR＋PR）36％，疾病控制率为68％，两组比较差异无统计学意义。吉非替尼组骨髓抑制及胃肠道反应等低于培美曲塞组，皮疹高于培美曲塞组，差异有统计学意义。结论培美曲塞联合奈达铂与吉非替尼治疗老年晚期肺腺癌的疗效相当，吉非替尼不良反应更轻，能为大多数老年患者耐受。%Objective To compare the short-term effect and adverse reaction between pemetrexed and gefitinib in the treatment of elderly advanced lungadenocarcinoma. Methods 50 elderly patients with phase IV lung adenocarcinoma,with EGFR mutation gene,were randomly divided into 2 groups. The pemetrexed group received 500 mg/m2 pemetrexed,ivgtt,d1,25 mg/m2 nedaplatin,ivgtt,d1 ~ 3,21 days for a cycle,a total of 4 to 6 cycles; the gefitinib groups received 250 mg gefitinib oral y,once per day,until disease progression. The curative effect and adverse reactions of two groups were evaluated. Results The effective rate in pemetrexed group was(CR+PR)32%,disease control rates was 64%,the effective rate in gefitinib group was(CR+PR)36%,disease control rates was 68%,there was no statistical difference between 2 groups. The bone marrow suppression and gastrointestinal reaction rate in gefitinib group was lower than pemetrexed group,rash rate was higher than the pemetrexed group, there were significant differences. Conclusion The clinical effects between pemetrexed combined with nedaplatin and gefitinib are in the treatment of elderly advanced lung adenocarcinoma,the adverse reaction in gefitinib groupis is lighter,most elderly patients can tolerate,it can become the first choice for elderly advanced lung adenocarcinoma.
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