Medical Oncology A, IRCCS-CRO, 33081 Aviano (PN), Italy.
Lung Cancer. 2010 May;68(2):264-8. doi: 10.1016/j.lungcan.2009.06.018. Epub 2009 Jul 25.
Brain metastases from Non-Small Cell Lung Cancer are usually associated with poor prognosis and up to now chemotherapy has shown a modest activity upon cerebral localizations. We investigated the role of Pemetrexed, a new, well tolerated multi-target antifolate, on brain metastases.
We collected 39 patients with evidence of cerebral nervous system (CNS) localizations from Non-Small Cell Lung Cancer (NSCLC) before starting treatment with Pemetrexed as second-line or further-line therapy.
We confirmed the good tolerability of Pemetrexed even in that setting of patients and we reported a progressive disease (PD) in 12 patients (30.8%), a stable disease (SD) and partial response (PR) in 12 (30.8%) and 15 (38.4%) patients respectively, with an overall clinical benefit obtained in 69% of patients. The cerebral response to Pemetrexed was interesting with a cerebral radiological benefit obtained in 32 patients (82%), while 7 patients only showed brain progressive disease. Overall median survival was 10 months. All irradiation-naïve patients and those with clear radiological evidence of cerebral progression after brain radiotherapy and before Pemetrexed, overall 22 patients, were included in one group, in order to avoid overlapping effects between brain radiotherapy and Pemetrexed over CNS localizations. Within that setting, we demonstrated an overall clinical benefit (SD+PR) and cerebral benefit in 63% and 68%, of patients respectively. Distribution of patients by overall response to Pemetrexed and CNS response was highly suggestive of activity of Pemetrexed on brain metastases.
We demonstrated the good tolerability of Pemetrexed even in patients with advanced NSCLC and brain metastases, and we found a very good overall response rate with evidence of activity on brain localizations.
目的：研究培美曲塞（一种新型、耐受性良好的多靶点抗叶酸药物）在脑转移瘤中的作用。
患者和方法：共纳入 39 例非小细胞肺癌（NSCLC）脑转移患者，这些患者在开始培美曲塞二线或三线治疗前有脑神经系统（CNS）定位证据。
结果：我们证实了培美曲塞在该患者人群中的良好耐受性，12 例（30.8%）患者出现疾病进展（PD），12 例（30.8%）和 15 例（38.4%）患者分别出现稳定疾病（SD）和部分缓解（PR），69%的患者获得了临床获益。培美曲塞对脑转移瘤的疗效令人感兴趣，32 例（82%）患者的脑部影像学有获益，而 7 例患者仅出现脑进展性疾病。总体中位生存期为 10 个月。所有未接受放疗的患者和那些在脑放疗后及培美曲塞治疗前有明确脑进展证据的患者（共 22 例）被归入一组，以避免脑放疗和培美曲塞对 CNS 定位的重叠作用。在该组中，我们观察到 63%和 68%的患者分别获得了总体临床获益（SD+PR）和脑部获益。患者对培美曲塞的总体反应和对 CNS 的反应分布强烈提示培美曲塞对脑转移瘤的活性。
结论：即使在晚期 NSCLC 伴脑转移瘤的患者中，我们也证实了培美曲塞的良好耐受性，并且观察到该药对脑转移瘤具有很好的总体反应率，提示该药对脑转移瘤具有活性。
