Shukuya Takehito, Takahashi Toshiaki, Imai Hisao, Tokito Takaaki, Ono Akira, Akamatsu Hiroaki, Taira Tetsuhiko, Kenmotsu Hirotsugu, Naito Tateaki, Murakami Haruyasu, Endo Masahiro, Yamamoto Nobuyuki
Divisions of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan; Divisions of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan.
Divisions of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Respir Investig. 2014 Mar;52(2):101-6. doi: 10.1016/j.resinv.2013.07.002. Epub 2013 Sep 13.
Cisplatin plus pemetrexed is a standard front-line chemotherapeutic regimen for inoperable malignant pleural mesothelioma (MPM). However, no clinical trials have compared the efficacy of cisplatin plus pemetrexed and cisplatin plus gemcitabine, which may be comparable based on previous phase II study results. This study aimed at evaluating the efficacy of cisplatin plus pemetrexed and comparing it with that of cisplatin plus gemcitabine in Japanese MPM patients.
From July 2002 to December 2011, 13 and 17 consecutive patients with inoperable MPM were treated with cisplatin plus gemcitabine and cisplatin plus pemetrexed, respectively, at the Shizuoka Cancer Center. We reviewed the medical charts of these patients and evaluated their characteristics as well as data regarding drug toxicity and antitumor efficacy.
The response rates were 15% and 35% in the cisplatin plus gemcitabine and cisplatin plus pemetrexed groups, respectively (P=0.4069), while disease control rates were 77%, and 82%, respectively (P=0.9999). Progression-free survival was significantly higher with cisplatin plus pemetrexed (median, 215.5 days) than with cisplatin plus gemcitabine (median, 142.5 days) (P=0.0146; hazard ratio [HR], 0.3552). Overall survival showed a tendency towards being superior with cisplatin plus pemetrexed (median, 597.5 days) compared with cisplatin plus gemcitabine (median, 306.5 days) (P=0.1725, HR, 0.5516). Hematological toxicities, especially thrombocytopenia and neutropenia, tended to be more frequent and severe in the cisplatin plus gemcitabine group.
Cisplatin plus pemetrexed may be superior and should continue to be the standard front-line chemotherapeutic regimen for inoperable MPM.
顺铂联合培美曲塞是不可切除恶性胸膜间皮瘤（MPM）的标准一线化疗方案。然而，尚无临床试验比较顺铂联合培美曲塞与顺铂联合吉西他滨的疗效，根据既往II期研究结果，二者疗效可能相当。本研究旨在评估顺铂联合培美曲塞在日本MPM患者中的疗效，并与顺铂联合吉西他滨进行比较。
2002年7月至2011年12月，静冈癌症中心分别对13例和17例连续的不可切除MPM患者采用顺铂联合吉西他滨和顺铂联合培美曲塞治疗。我们回顾了这些患者的病历，评估了他们的特征以及药物毒性和抗肿瘤疗效的数据。
顺铂联合吉西他滨组和顺铂联合培美曲塞组的缓解率分别为15%和35%（P = 0.4069），而疾病控制率分别为77%和82%（P = 0.9999）。顺铂联合培美曲塞组的无进展生存期显著高于顺铂联合吉西他滨组（中位值，215.5天）（中位值，142.5天）（P = 0.0146；风险比[HR]，0.3552）。总生存期显示，顺铂联合培美曲塞组（中位值，597.5天）与顺铂联合吉西他滨组（中位值，306.5天）相比有更优的趋势（P = 0.1725，HR，0.5516）。血液学毒性，尤其是血小板减少和中性粒细胞减少，在顺铂联合吉西他滨组往往更频繁和严重。
顺铂联合培美曲塞可能更优，应继续作为不可切除MPM的标准一线化疗方案。
