Pemetrexed versus Gefitinib versus Erlotinib in Previously Treated Patients with Non-Small Cell Lung Cancer
Pemetrexed versus Gefitinib versus Erlotinib in Previously Treated Patients with Non-Small Cell Lung Cancer
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DOI：
10.3904/kjim.2010.25.3.294
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发表时间：
2010-09-01
影响因子：
2.4
通讯作者：
Lee, Jae Hoon
中科院分区：
文献类型：
--
作者：
Hong, Junshik;Kyung, Sun Young;Lee, Jae Hoon
背景/目标。比较培美曲塞、吉非替尼和厄洛替尼在既往接受过治疗的非小细胞肺癌（NSCLC）患者中的疗效和安全性。研究患者符合以下标准，组织学证实，既往接受过治疗的晚期（IIIB或IV期）或复发性NSCLC，可测量的病变; 18岁，东部肿瘤协作组体能状态0 - 2，既往未暴露于三种研究药物患者接受培美曲塞500 mg/m2静脉注射，每3周一次，并补充维生素，吉非替尼（250 mg/天口服）或厄洛替尼（150 mg/天口服）结果。57例其中培美曲塞组20例，吉非替尼组20例，厄洛替尼组17例。与其他组相比，培美曲塞组男性、吸烟者和鳞状细胞癌患者的数量增加。疾病控制率（DCR）分别为5.3%、40.0%和50.0%（P <0.01）。中位无进展生存期（PFS）为1.7、3.5和4.4个月中位生存期分别为5.6、21.8和21.5个月（p = 0.04），分别在亚组分析中，非鳞状组织学患者，男性，有吸烟史的受试者使用吉非替尼和厄洛替尼的DCR和PFS均高于培美曲塞。结论两种口服表皮生长因子受体酪氨酸激酶抑制剂（EGFR TKIs）的疗效和安全性相当，但EGFR TKIs的基线临床特征优于培美曲塞，其上级PFS和OS均优于培美曲塞，提示基线临床病理因素的影响。（Korean J Intern Med 2010;25：294-300）
Background/Aims. The efficacy and safety of pemetrexed, gefitinib, and erlotinib administration in previously treated patients with non-small cell lung cancer (NSCLC) were compared.Methods. The study patients met the following criteria histologically confirmed, previously treated advanced (stage IIIB or IV) or recurrent NSCLC, a measurable lesion; 18 years of age, Eastern Cooperative Oncology Group Performance status 0 to 2, and no prior exposure to the three study drugs Patients received 500 mg/m(2) of pemetrexed intravenously every 3 weeks with vitamin supplementation, gefitinib (250 mg/day per os), or erlotinib (150 mg/day per os)Results. Of 57 patients (pemetrexed, 20, gefitinib, 20, and erlotinib, 17), 55 were evaluated for a response The numbers of males, smokers, and squamous histology were increased in the pemetrexed group compared to the other groups The objective response rates were 5.3%, 25 0%, and 12 5% (p = 0 22), and the disease control rates (DCR) were 5.3%, 40 0%, and 50 0%, respectively (p < 0 01). The median progression-free survival (PFS) was 1.7, 3.5, and 4.4 months (p < 0 01) and the median overall survival (OS) was 5.6, 21.8, and 21 5 months (p = 0.04), respectively In subgroup analyses, patients with non-squamous histology, males, and a smoking history had a higher DCR and longer PFS with gefitinib and erlotinib than with pemetrexed. All three chemotherapeutic agents had manageable toxicities.Conclusions Both oral epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) had comparable efficacy and safety The superior PFS and OS of EGFR TKIs with more favorable baseline clinical characteristics than those of pemetrexed suggest the impact of baseline clinicopathological factors. (Korean J Intern Med 2010;25:294-300)