- 期刊
Pemetrexed Treatment in Non-Small Cell Lung Cancer Patients Failing Previous Platinum-based Chemotherapy and with/without Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment
使用pemetrexed治療曾經使用含鉑化療藥品並也曾或不曾使用上皮細胞生長因素接受體抑制劑失敗的非小細胞肺癌病患
摘要
背景：pemetrexed可有效使用於曾經化療生效的非小細胞肺癌病患。本文章的目的就是要探討pemetrexed使用於經含鉑化療藥品並曾經或未曾接受上皮細胞生長因素接受體抑制劑生效的台灣人非小細胞肺癌病患的療效。 方式：使用pemetrexed每三週注射500 mg/平方公尺，並使用含類固醇與維他命的標準事前給藥。 結果：於2005年6月至2006年11月，共44人接受治療。其中有30位病患在含鉑藥品治療失敗後有再接受上皮細胞生長因素接受體抑制劑的治療，再度失敗後才接受pemetrexed治療。所有病患的平均年齡是62歲。接受pemetrexed治療療程中值數是4週期，腫瘤反應率是18.2%，只有少數且輕微的副作用。第三或四度骨髓造血功能的抑制包括18.2%的病患中性白血球下降，6.8%的病患血小板下降，4.5%的病患貧血。非造血功能方面的副作用均低於第三度的毒性。到病患惡化的中值時間是4.4個月，中值存活時間是12.2個月。以pemetrexed為第二線治療的反應率比當三線或更後的治療反應率高（40%比11.8%，p=0.043）先前是否使用過上皮細胞生長因素接受體抑制劑並不影響病患對本治療的反應率(p=0.782)。 結論：對先前使用含鉑化療失敗的非小細胞肺癌病患使用pemetrexed治療，產生的副作用低，耐受性好，腫瘤反應率也好。使用pemetrexed於二線治療會比三線或更後線的反應率高。
並列摘要
Background: Pemetrexed is an effective salvage agent in NSCLC. Our aim was to evaluate the efficacy of pemetrexed in NSCLC patients who had failed previous platinum-based chemotherapy and had been salvaged with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment or not. Methods: Treatment consisted of pemetrexed 500 mg/m^2 intravenous infusion on day 1 of every 3 weeks. Standard premedications were given. Results: Between June 2005 and November 2006, 44 patients (pts) were treated. Thirty pts had been treated with TKI after they failed platinum-based chemotherapy. The mean age was 62. The median number of cycles received was 4, and the objective response rate was 18.2%. Treatment-related toxicities were mild and few. Grade 3 or 4 hematological toxicities included neutropenia in 18.2%, thrombocytopenia in 6.8%, and anemia in 4.5% of pts. Non-haematological toxicities were all less than grade 3. Median time to disease progression was 4.4 months and median survival was 12.2 months. Those who received the present treatment as second-line treatment had a better response than those who received the treatment as third-line or later (40% vs. 11.8%, p=0.043). Previous treatment with EGFR-TKI or not did not affect patient response to the present treatment (p=0.782). Conclusions: Pemetrexed salvage chemotherapy in NSCLC patients who have failed previous platinum-based chemotherapy produces a relatively lower toxicity profile, and a better compliance and response rate than conventional salvage chemotherapy. Use of pemetrexed as a second-line agent will yield a better response rate than as a third line or later treatment.
延伸閱讀
- Lin, C. H., Wang, P. H., Kuo, Y. W., & Ho, C. C. (2017). Gefitinib 對於未接受化學治療的 Exon 19 deletion 及 L858R 二種基因變異之肺腺癌病患有相同療效. 胸腔醫學, 32(1), 14-23. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201702-201701240009-201701240009-14-23
- 陳崇裕（2017）。Astrocyte-elevated gene-1基因可調控增加thymidylate synthase的過度表現造成非小細胞肺癌pemetrexed治療後產生抗藥性〔博士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU201704265
- Lee, K. L., Lin, S. E., Chung, C. C., Hsiao, S. H., & Chung, C. L. (2015). 具表皮細胞生長因子接受器突變之肺麟狀細胞癌病患使用上皮細胞生長因子接收器－酪胺酸酶抑制劑呈顯著治療效果：病例報告. 胸腔醫學, 30(3), 157-163. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201506-201505290009-201505290009-157-163
- Huang, P. J. (2022). 表皮生長因子受體酪胺酸酶抑制劑併用血管內皮生長因子抑制劑在未接受治療、EGFR突變、晚期非小細胞肺癌:系統性回顧和統合分析、第三期臨床試驗計畫書 [master's thesis, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU202202991
- Fan, W. C., Chen, Y. M., Shih, J. F., Lee, Y. C., & Perng, R. P. (2009). 非小細胞肺癌病患使用Pemetrexed接著Docetaxel或相反順序之治療評估. 中華民國癌症醫學會雜誌, 25(6), 403-412. https://doi.org/10.6588/JCOS.2009.25.6.2