培美曲塞联合顺铂二线治疗晚期胃癌的临床观察

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。

Clinical observation of pemetrexed combined with cisplatin as second-line treatment in advanced gastric cancer

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＆#177;4.3 after chemotherapy, higher than 65.7＆#177;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.