培美曲塞联合顺铂二线治疗晚期胃癌的临床观察

摘要

目的：评价培美曲塞联合顺铂二线治疗晚期胃癌的疗效及不良反应。方法选取2011年12月至2013年2月46例一线化疗失败的晚期胃癌患者，给予培美曲塞联合顺铂二线治疗，具体为：培美曲塞500mg／m2静滴，d1；顺铂25mg／m2静滴，d1～d3；21天为1周期。根据RECIST 1�0版标准评价近期疗效并计算有效率（ RR）和疾病控制率（ DCR），同时采用NCI CTC 3�0标准评价毒副反应，随访无进展生存期（ PFS）和总生存期（ OS）。结果46例均可评价近期疗效，其中无完全缓解病例，部分缓解10例，稳定12例，进展24例，RR为21�7％，DCR为47�8％。随访3～20个月，中位PFS和OS分别为3�5个月和8�4个月。全组化疗后的KPS评分为（77�6±4�3）分，高于化疗前的（65�7±5�0）分（P＜0�05），但化疗前后止痛药使用率的差异无统计学意义（ P＞0�05）。主要毒副反应为1～3级骨髓抑制和胃肠道不良反应，4级毒副反应发生率极低，仅1例4级白细胞减少；2例1级肝功能异常；患者均无肾功能异常、发热、皮疹及化疗相关性死亡。结论培美曲塞联合顺铂二线治疗晚期胃癌的疗效较好，且毒副反应轻，耐受性好。%Objective To evaluate the efficacy and toxicity of pemetrexed combined with cisplatin as second-line treatment in advanced gastric cancer. Methods Forty-six patients with advanced gastric cancer who had previously failed to first-line chemotherapy from December 2011 to February 2013 received pemetrexed (500mg/m2 iv, d1) combined with cisplatin (25mg/m2 iv, d1-d3) as second-line treatment. Twenty-one days was a cycle. The response evaluation criteria in solid tumors ( RECIST) 1�0 was employed to evaluate the short-term efficacy and calculated the response rate (RR) and disease control rate (DCR). The toxicity was evaluated using NCI CTC 3�0 criteria. Progression-free survival (PFS) and overall survival (OS) were calculated from the date of follow-up. Results Forty-six patients were evaluable for short-term efficacy. There were 10 cases of partial response, 12 of stable disease and 24 of progressive disease with RR of 21�7%and DCR of 47�8%. The follow-up ranged from 3 to 20 months. The median PFS and OS were 3�5 and 8�4 months, re-spectively. The KPS was 77�6±4�3 after chemotherapy, higher than 65�7±5�0 before chemotherapy, but there was no significant differ-ence on painkiller usage before and after chemotherapy. The major side effects were grade 1-3 marrow toxicities and gastrointestinal re-sponse. The incidence of grade 4 side effect was rare with only one case of grade 4 leukopenia. Two cases were grade 1 abnormal liver function. There was no renal dysfunction, fever, rash and chemotherapy-related deaths. Conclusion Pemetrexed combined with cisplatin as second-line treatment in advanced gastric cancer showed a good effect with mild toxicities and good tolerance.