- 期刊
Favorable Response to Pemetrexed as a Salvage Agent for Patients with Advanced Lung Cancer Who Have Failed Conventional Platinum-Based Chemotherapy and EGFR Tyrosine Kinase Inhibitors
Pemetrexed對含鉑化療及EGFR酪氨酸激酶抑制劑無效的非小細胞型肺癌仍有良好的療效
摘要
背景：對於局部晚期或轉移性之非鳞狀細胞型非小細胞型肺癌，Pemetrexed目前可與鉑類藥物併用作為第一線用藥或於含鉑化學治療後的第二線用藥，但有關此藥用於第三線治療的療效及此藥於第三線使用時，EGFR及K-ras基因突變對其反應的影響的相關文獻很少。 方法：我們回溯分析此藥用於已對第一線含鉑化療及對erlotinib或gefitinib無效後的病人時，病人性別、performance status、給藥週期數、EGFR及K-ras基因突變型態、化療反應、不良反應，及有效期及整體存活對此藥療效之影響。 結果：平均病人使用6.17週期，十一個病人中有六個有部份反應，三個穩定疾病，兩個無效。平均有效期及整體存活為108天及346天。EGFR基因突變的有無不影響療效，此藥用於第三線的耐受良好，無病人須作劑量調整。 結論：pemetrexed對performance status良好的病人在其對第一線含鉑化療及EGFR酪氨酸激酶抑制劑無效時仍為良好選擇。
並列摘要
Background: For locally advanced or metastatic non-squamous non-small cell lung cancer (NSCLC), pemetrexed is currently recommended as first-line treatment in combination with platinum agents or second-line chemotherapy after the disease has become refractory to platinum-based doublet regimens, but few reports have addressed its role as salvage chemotherapy after failure of multiple therapies and the relationship between response rate and EGFR and K-ras mutations. Methods: We retrospectively evaluated the efficacy of pemetrexed in 11 patients with advanced NSCLC, who had failed at least platinum-based doublet combinations and erlotinib or gefitinib. The gender, performance status, number of cycles given, EGFR and K-ras mutation status, best response, adverse reactions, time to progression (TTP) and overall survival (OS) were used to assess the effects. Results: A median of 6.17 cycles of infusion was given. Six out of 11 patients experienced partial response, three stable disease and two disease progression. The TTP and OS of salvage pemetrexed therapy were 108 and 346 days, respectively. The EGFR mutation status did not affect its efficacy. It was well-tolerated and required no dose modification. Conclusions: Pemetrexed is a good option for patients with good performance status who have failed platinum-and taxane-containing regimens and EGFR tyrosine kinase inhibitors.
延伸閱讀
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- 劉錦鳳、鄭幸宜、李樂業（2018）。Erlotinib用於肺腺癌EGFR野生型患者化學治療後之療效探討。臺灣臨床藥學雜誌，26(1)，47-58。https://doi.org/10.6168/FJCP.201801_26(1).0006
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- Chen, Y. M., Perng, R. P., Tsai, C. M., & Peng, J. W. (2008). 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. 中華民國癌症醫學會雜誌, 24(6), 347-355. https://doi.org/10.6588/JCOS.2008.24.6.2