Division of Thoracic Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104 , USA.
Clin Lung Cancer. 2010 May;11(3):192-7. doi: 10.3816/CLC.2010.n.025.
The purpose of this study was to determine the efficacy and tolerability of carboplatin, pemetrexed, and bevacizumab in patients with advanced, nonsquamous non-small-cell lung cancer (NSCLC).
The charts of consecutive patients with stage IIIB/IV nonsquamous NSCLC were reviewed. All patients receiving at least 1 cycle of the 3-drug regimen (pemetrexed 500 mg/m2, carboplatin area under the curve of 5-6, bevacizumab 15 mg/kg intravenously), were included for assessment of response, safety, and toxicity.
A total of 27 patients received this regimen between February 2008 and July 2009; 63% were women. Median follow-up was 6.3 months (range, 1.6-21.1 months). Median number of cycles was 6 (range, 1-6 cycles); 67% completed 6 cycles; 83% went on to receive maintenance bevacizumab/pemetrexed. Among those who received maintenance, the median number of cycles administered was 4.5 (range, 1-18 cycles). Response rate was 52%; stable disease was observed in another 40%. On the basis of Kaplan-Meier analysis, actuarial overall survival was 83% at 12 months; actuarial progression-free survival was 83% and 63% at 6 and 12 months, respectively. Clinical improvement was noted in 41% of the patients, with clinical stability in another 48%. Grade 2 and 3 toxicities from the regimen included anemia (11% and 15%), fatigue (37% and 7.4%), febrile neutropenia (7.4%; grade 3 only), thrombocytopenia (7.4% and 0), and thromboembolic disorders (3.7% and 3.7%). Bevacizumab-induced side effects (any grade) included headaches (22.2%), epistaxis (30%), hemoptysis (3.7%), and hypertension (11%). No grade 4 or 5 toxicities were seen.
Combination carboplatin/pemetrexed and bevacizumab followed by maintenance therapy with pemetrexed/bevacizumab is effective, with response rates > 50%, acceptable toxicity, and promising early survival in patients with advanced nonsquamous NSCLC.
本研究旨在确定卡铂、培美曲塞和贝伐单抗在晚期非鳞状非小细胞肺癌（NSCLC）患者中的疗效和耐受性。
对连续的 IIIB/IV 期非鳞状 NSCLC 患者的病历进行了回顾。所有至少接受 1 个周期 3 药联合方案（培美曲塞 500mg/m2，卡铂 AUC 为 5-6，贝伐单抗 15mg/kg 静脉注射）的患者均纳入疗效、安全性和毒性评估。
2008 年 2 月至 2009 年 7 月期间，共有 27 例患者接受了该方案治疗；63%为女性。中位随访时间为 6.3 个月（1.6-21.1 个月）。中位周期数为 6（1-6 个周期）；67%完成了 6 个周期；83%继续接受维持性贝伐单抗/培美曲塞治疗。在接受维持治疗的患者中，中位周期数为 4.5（1-18 个周期）。客观缓解率为 52%；另有 40%疾病稳定。根据 Kaplan-Meier 分析，12 个月时的总生存率为 83%；6 个月和 12 个月时的无进展生存率分别为 83%和 63%。41%的患者临床状况改善，另有 48%患者临床状况稳定。该方案引起的 2-3 级毒性包括贫血（11%和 15%）、乏力（37%和 7.4%）、发热性中性粒细胞减少症（7.4%；仅 3 级）、血小板减少症（7.4%和 0）和血栓栓塞性疾病（3.7%和 3.7%）。贝伐单抗相关不良反应（任何级别）包括头痛（22.2%）、鼻出血（30%）、咯血（3.7%）和高血压（11%）。未观察到 4 级或 5 级毒性。
卡铂/培美曲塞联合贝伐单抗序贯培美曲塞/贝伐单抗维持治疗在晚期非鳞状 NSCLC 患者中有效，缓解率>50%，毒性可接受，早期生存有希望。
