目的比较培美曲塞和多西他赛在老年晚期非鳞非小细胞肺癌(NSCLC)二线治疗中的疗效和安全性。方法收集2009年1月至2012年3月首都医科大学宣武医院胸外科收治的年龄≥65岁晚期非鳞NSCLC患者的病历资料进行回顾性分析。按照化疗方案将患者分为培美曲塞组(500 mg/m~2静脉滴注,第1天)和多西他赛组(75 mg/m~2静脉滴注,第1天)。每个治疗周期均约3~4周。比较2组患者治疗2个周期后的客观有效率、疾病控制率和不良反应发生率。结果纳入分析的患者共146例。培美曲塞组56例,男性30例,女性26例,年龄65~83岁,平均(69.6±4.7)岁;多西他赛组90例,男性62例,女性28例,年龄65~83岁,平均(67.9±4.5)岁。2组患者肺癌病理类型、分期和体力状况评分差异均无统计学意义。治疗2个周期后培美曲塞组客观有效率明显高于多西他赛组[32.1%(18/56)比17.8%(16/90),P=0.046],疾病控制率培美曲塞组与多西他赛组差异无统计学意义[73.2%(41/56)比77.8%(16/90),P=0.530]。2组均有患者出现粒细胞减少、血小板减少、贫血、恶心呕吐、周围神经毒性、脱发等不良反应,培美曲塞组Ⅲ~Ⅳ级粒细胞减少、脱发和Ⅰ~Ⅱ级周围神经毒性发生率均明显低于多西他赛组[7.1%(4/56)比27.8%(25/90),P=0.001;21.4%(12/56)比52.2%(47/90),P=0.000;17.9%(10/56)比33.3%(30/90),P=0.04)]。2组均无发生肾功能损害者及因化疗不良反应而死亡者。结论培美曲塞和多西他赛用于老年晚期非鳞NSCLC二线治疗均有效,但培美曲塞较多西他赛更安全。 Objective To compare the efficacy and safety of pemetrexed and docetaxel in the second-line treatment of advanced non-squamous non-small cell lung cancer (NSCLC). Methods The clinical data of patients with advanced non-squamous NSCLC aged 65 years and older who were admitted to Xuanwu Hospital, Capital Medical University from January 2009 to March 2012 were retrospectively analyzed. Patients were divided into pemetrexed group (500 mg / m 2 intravenous infusion, day 1) and docetaxel group (75 mg / m 2 intravenous infusion, day 1) according to the chemotherapy regimen. Each treatment cycle are about 3 to 4 weeks. The objective efficiency, disease control rate and incidence of adverse reactions after 2 cycles of treatment were compared between the two groups. Results A total of 146 patients were included in the analysis. Pemetrexed group of 56 patients, 30 males and 26 females, aged 65 to 83 years (mean, 69.6 ± 4.7) years; docetaxel group, 90 patients, 62 males and 28 females, aged 65 to 83 Years old, with an average of (67.9 ± 4.5) years old. There was no significant difference in the pathological types, staging and physical status between the two groups. The objective effective rate of pemetrexed group after 2 cycles of treatment was significantly higher than that of docetaxel group (32.1% (18/56) vs. 17.8% (16/90), P = 0.046], disease control rate pemetrexed There was no significant difference between the group and the docetaxel group [73.2% (41/56) vs 77.8% (16/90), P = 0.530]. Patients in both groups had neutropenia, thrombocytopenia, anemia, nausea and vomiting, peripheral neurotoxicity, hair loss and other adverse reactions. Pemetrexed group Ⅲ ~ Ⅳ neutropenia, hair loss and grade Ⅰ ~ Ⅱ peripheral neurotoxicity Rates were significantly lower in the docetaxel group than in the docetaxel group (7.1% (4/56) vs. 27.8% (25/90), P = 0.001; 21.4% (12/56) vs. 52.2% (47/90) ; 17.9% (10/56) vs. 33.3% (30/90), P = 0.04)]. Neither group had renal dysfunction and those who died of adverse reactions due to chemotherapy. Conclusions Both pemetrexed and docetaxel are effective in second-line treatment of advanced non-squamous NSCLC, but pemetrexed is more safe than docetaxel.