CAJ | 학술논문

背景与目的：目前，晚期肺腺癌主要依靠以化疗为主的综合治疗。培美曲塞作为一种多靶点抗叶酸制剂，与铂类药物联合应用治疗晚期肺腺癌，因其疗效好、不良反应轻而受到推崇。本研究比较培美曲塞与多西他赛联合铂类一线治疗晚期肺腺癌的效果及不良反应。方法：将50例晚期肺腺癌患者随机分为培美曲塞＋顺铂(PC)组和多西他赛＋顺铂(TP)组。每组各25例患者。PC组：培美曲塞500 mg/m2静脉滴注，第1天；顺铂75 mg/m2静脉滴注，第1天。TP组：多西他赛75 mg/m2静脉滴注，第1天；顺铂75 mg/m2静脉滴注，第1天。两组1个周期均为21 d。比较两组的有效率(response rate，RR)、疾病控制率(disease control rate，DCR)、无进展生存期(progression-free survival，PFS)和总生存期(overall survival，OS)。测定外周血T淋巴细胞亚群活性，评价两组患者免疫功能。结果：50例患者均可评价疗效及不良反应，两组均无完全缓解(complete remission，CR)病例，部分缓解(partial remission，PR)20例，疾病稳定(stable disease， SD)17例，疾病进展(progressive disease，PD)13例。PC组与TP组的RR、DCR、PFS和OS差异均无统计学意义(P>0.05)。PC组治疗后与TP组相比，CD3＋、CD4＋、CD4＋/CD8＋T细胞和NK细胞活性均升高，CD8＋T细胞活性降低，但差异无统计学意义(P＞0.05)。两组的不良反应主要为骨髓抑制和消化道反应，PC组Ⅲ~Ⅳ级不良反应白细胞减少、血小板减少、消化道症状和乏力的发生率低于TP组，差异有统计学意义(P<0.05)。结论：培美曲塞与多西他赛联合顺铂治疗晚期肺腺癌的临床疗效相当，但前者可降低不良反应发生率。
배경여목적：목전，만기폐선암주요의고이화료위주적종합치료。배미곡새작위일충다파점항협산제제，여박류약물연합응용치료만기폐선암，인기료효호、불량반응경이수도추숭。본연구비교배미곡새여다서타새연합박류일선치료만기폐선암적효과급불량반응。방법：장50례만기폐선암환자수궤분위배미곡새＋순박(PC)조화다서타새＋순박(TP)조。매조각25례환자。PC조：배미곡새500 mg/m2정맥적주，제1천；순박75 mg/m2정맥적주，제1천。TP조：다서타새75 mg/m2정맥적주，제1천；순박75 mg/m2정맥적주，제1천。량조1개주기균위21 d。비교량조적유효솔(response rate，RR)、질병공제솔(disease control rate，DCR)、무진전생존기(progression-free survival，PFS)화총생존기(overall survival，OS)。측정외주혈T림파세포아군활성，평개량조환자면역공능。결과：50례환자균가평개료효급불량반응，량조균무완전완해(complete remission，CR)병례，부분완해(partial remission，PR)20례，질병은정(stable disease， SD)17례，질병진전(progressive disease，PD)13례。PC조여TP조적RR、DCR、PFS화OS차이균무통계학의의(P>0.05)。PC조치료후여TP조상비，CD3＋、CD4＋、CD4＋/CD8＋T세포화NK세포활성균승고，CD8＋T세포활성강저，단차이무통계학의의(P＞0.05)。량조적불량반응주요위골수억제화소화도반응，PC조Ⅲ~Ⅳ급불량반응백세포감소、혈소판감소、소화도증상화핍력적발생솔저우TP조，차이유통계학의의(P<0.05)。결론：배미곡새여다서타새연합순박치료만기폐선암적림상료효상당，단전자가강저불량반응발생솔。
Background and purpose:At present, the advanced lung adenocarcinoma is mainly treated by chemotherapy-oriented comprehensive therapy. Pemetrexed as a multi-target antifolate chemotherapeutic drug, combined with platinum, was approved for treatment of advanced lung adenocarcinoma because of its low toxicity and high efifcacy. The purpose of this study was to compare the short-term clinical efifcacy and toxicity of pemetrexed and docetaxel combined with cisplatin for advanced lung adenocarcinoma.Methods:Fifty patients with stageⅢ-Ⅳ lung adenocarcinoma were randomly divided into two groups. Group PC received pemetrexed (500 mg/m2, d1) combined with cisplatin (75 mg/m2, d1) and group TP received docetaxel (75mg/ m2, d1) combined with cisplatin (75 mg/m2, d1) treatment. One cycle was 21 days in both two groups. The response rate (RR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) of the two groups were compared. The peripheral blood T lymphocyte subsets and natural killer (NK) cell activity of patients in both groups were measured before and after the treatment, while compared with healthy controls (25 cases).Results:Among 50 patients, no one got complete remission (CR), 20 patients got partial remission (PR), 17 patients had stable disease (SD) and 13 patients had progressive disease (PD).It showed no signiifcant difference in RR, DCR, PFS and OS (P>0.05) between two groups. Compared with group TP, the activity of CD3+, CD4+, CD4+/CD8+ T cells and NK cells increased and CD8+ T cells reduced in group PC after treatment, but the value had no obvious change (P>0.05). The common side effects were hematological toxicity and gastrointestinal response. The incidence of side effects in group PC was lower than that in group TP, and the degree was also slighter (P<0.05).Conclusion:The clinical efifcacy of pemetrexed combined with cisplatin is equal to docetaxel combined with cisplatin in treatment of advanced lung adenocarcinoma, but the former could reduce the adverse reaction rate.