培美曲塞|培美曲塞治疗非小细胞肺癌的最新进展( 二 )

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培美曲塞+靶向治疗
多项研究显示，培美曲塞在肺腺癌中效果优于其他类型。而靶向治疗在肺腺癌中如火如荼的开展。那么二者是否可以联合呢？一项开放性 IB期临床研究显示[11]，一线含铂化疗与培美曲塞+厄洛替尼进行对照，后者每3周接受培美曲塞500-700 mg /m，口服厄洛替尼100-150 mg /天，与两药单用相比，两药联合病人的耐受性较好。
此外，培美曲塞联合靶向治疗也在临床中推荐使用。La Monica等[12]报道的一项体外研究也证实了奥希替尼显著抑制肿瘤生长，并确定了奥希替尼+培美曲塞+顺铂这一组合，通过延迟奥希替尼耐药的发生，有益于治疗NSCLC患者。
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与放疗联合
放射治疗在晚期肺癌局部治疗中发挥重要的作用，有许多药物作为放疗增敏剂在放疗中应用，起协同作用。一项Ⅱ期研究[13]显示，纳入的19名患者予以培美曲塞500-700 mg /m IV，LDR（40cGy on days 1 and 2）,21天为一周期，每周期重复四次。结果显示，只有一名患者出现4级中性粒细胞减少症，总反应率为42% 。在培美曲塞联合放疗期间，应注意培美曲塞的用量，以减少毒性反应。
在PROCLAIM研究[中[14]，将培美曲塞+顺铂同步胸部放疗与依托泊苷+顺铂同步胸部放疗对照，其后均跟巩固化疗，结果显示两者OS相当，但培美曲塞组嗜中性粒细胞减少症明显少于EP组（24.4% vs.44.5%）。
展望
培美曲塞是一种多靶点的抗代谢药物，目前尚没有明确的分子标志物，有待进一步探索实现精准治疗。培美曲塞不仅在非小细胞肺癌中与抗血管药物、靶向药物、免疫药物、放射治疗等联和取得了良好的效果。在其他瘤种如恶性胸膜间皮瘤也被推荐使用，希望以后开辟更多的应用，为肿瘤患者带来福音。
参考文献
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