【摘要】 目的评价多西他赛、培美曲塞、厄洛替尼和吉非替尼4种方案二线治疗晚期非小细胞肺癌(NSCLC)的疗效,并进行成本效益分析。方法 160例晚期NSCLC患者按二线治疗方案分为4组,每组40例。4种方案分别为:多西他赛75mg/m2iv.,d1;培美曲塞500mg/m2iv.,d1;厄洛替尼150mg,每日1次;吉非替尼250mg,每日1次。前两组以21天为1周期,共化疗2～6个周期;后两组口服至病情进展或出现无法耐受的不良反应停药。对所有患者进行近期疗效和无进展生存期(PFS)评价,以获得1个单位(1个月)PFS的花费计算4种方案的成本效益比。结果多西他赛组、培美曲塞组、厄洛替尼组、吉非替尼组有效率分别为7.5%、10.0%、20.0%和22.5%(P=0.165);疾病控制率分别为32.5%、50.0%、65.0%和52.5%(P=0.035);中位PFS分别为2.7个月、2.8个月、3.5个月和3.5个月(P=0.677)。4种方案的3～4级不良反应以多西他赛多见。每获得1个单位PFS,4种方案的花费分别为5635.6、10 279.6、20 814.0和17 587.8元;以多西他赛组为参照,培美曲塞组、厄洛替尼组和吉非替尼组的成本-效益比分别为46 434.7、119 729.4和103 171.0元/月。敏感度分析与成本效益分析的结论一致。结论多西他赛、培美曲塞、厄洛替尼和吉非替尼4种二线治疗方案治疗晚期NSCLC的疗效未见差异,多西他赛方案的成本-效益比最优;厄洛替尼或吉非替尼治疗的花费高,但不良反应较轻。更多还原

【Abstract】 Objective To evaluate the effect and cost-efficacy of the second-line treatment of advanced non-small cell lung cancer(NSCLC) by regimens of docetaxel,pemetrexed,erlotinib and gefitinb.Methods A total of 160 patients with advanced NSCLC were assigned to docetaxel,pemetrexed,erlotinib and gefitinb groups(40 cases in each group).The dosages of the 4 drugs were docetaxel 75mg/m2 dl,pemetrexed 500mg/m2 dl,erlotinib 150 mg/d and gefitinb 250mg/d.The former two regimens were given 2-6 cycles(21 days as a cycle).The later two regimens were given till the disease progressed or intolerant side effect emerged.The effective rate,disease control rate,progress-free survival(PFS) and cost-efficacy ratio were analyzed.Results The effective rate of docetaxel,pemetrexed,erlotinib and gefitinb group was 7.5%,10.0%,20.0% and 22.5%(P=0.165);disease control rate was 32.5%,50.0%,65.0% and 52.5%(P=0.035);median PFS was 2.7,2.8,3.5 and 3.5months(P=0.677);the cost of per unit(1 month) increasing of PFS was 5635.6,10 279.6,20 814.0 and 17 587.8 yuan.Taking docetaxel group as control,the cost-efficacy ratio of pemetrexed,erlotinib and gefitinb group was 46 434.7,119 729.4 and 103 171.0 yuan/month.The sensitivity analysis supported the results of benefit-cost evaluation.Conclusion Docetaxel,pemetrexed,erlotinib and gefitinb have no statistically significance in the second-line treatment of advanced NSCLC.Docetaxel had better cost-efficacy.Erlotinib and gefitinb have less side effects but the most expensive cost.更多还原