Objective To explore the efficacy and toxicity of pemetrexed versus docetaxel in patients with advanced non-small cell lung cancer(NSCLC) previously treated with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs). Methods In this retrospective study, 67 cases of NSCLC patients failed to EGFR-TKIs were enrolled. According to the treatment regimen, the pa-tients were assigned to receive docetaxel(75 mg/ m2 d1 , n= 31) or pemetrexed(500 mg/ m2 d1 , n= 36) with 21 days for a cycle. The efficacy was evaluated according to response evaluation criteria in solid tumors(RECIST 1. 1). The toxicity was evaluated by interna-tional standard adverse reaction NCI CTC 3. 0 version. The long-term survival was followed up and the Cox hazard regression model to analyze the influencing factors for the prognosis. Results All patients can be evaluated for the short-term efficacy. The response rates of pemetrexed group and docetaxel group were 19. 4% and 12. 9%, and disease control rates were 58. 3% and 41. 9% without signifi-cant difference(P>0. 05). In pemetrexed group, the incidence of grade 3-4 white blood cell reduction, thrombocytopenia, skin rash and elevated aminotransferase were all lower than that of docetaxel group(P<0. 05). The median progression free survival(PFS) was 6. 4 months in the pemetrexed group, higher than 4. 7 months in docetaxel group with significant differences(P<0. 05). No significant difference was observed in the median overall survival between both groups(P>0. 05). Factors affecting the PFS included age, clinical stage, pathological type, PS score and save program. Conclusion Similar efficacy was observed between pemetrexed and docetaxel in NSCLC patients failed to EGFR-TKIs. However, the median PFS was relatively high, and the side effects were slight and could be tol-erated in pemetrexed regiem. In view of the factors influencing the prognosis, it could be recommended to use in the treatment of the patients.%目的：比较培美曲塞与多西他赛在非小细胞肺癌（NSCLC）靶向治疗失败后挽救化疗中的有效性和安全性。方法回顾性分析本院收治的67例靶向治疗失败行挽救化疗的 NSCLC 患者，根据挽救化疗方案分为培美曲塞组（培美曲塞500 mg／ m2， d1， n＝36）和多西他赛组（多西他赛75 mg／ m2， d1， n＝31），21天为1周期。分析两组的近期疗效、毒副反应和远期疗效，采用 Cox 风险比例模型分析影响预后的因素。结果67例患者均可评价近期疗效。培美曲塞组和多西他赛组的有效率分别为19．4％和12．9％，疾病控制率分别为58．3％和41．9％，差异均无统计学意义（P＞0．05）。培美曲塞组的3～4级毒副反应包括白细胞减少、血小板减少、皮疹和转氨酶升高的发生率均低于多西他赛组（P＜0．05）。培美曲塞组的中位无进展生存期（PFS）为6．4个月，高于多西他赛组的4．7个月（P＜0．05），但两组的中位总生存期（OS）的差异无统计学意义（10．2个月vs．9．8个月，P＞0．05）。 Cox 风险比例模型显示，年龄、临床分期、病理类型、PS 评分和挽救方案均为影响靶向治疗失败 NSCLC患者的 PFS 的独立因素。结论培美曲塞在 NSCLC 靶向治疗失败挽救化疗中的近期疗效与多西他赛相当，且中位 PFS 略有延长，毒副作用低，值得临床上推广使用。
展开▼
