中国肺癌杂志2025，Vol.28Issue(8)：567-575,9.DOI:10.3779/j.issn.1009-3419.2025.106.23
培美曲塞鞘内化疗在EGFR阳性非小细胞肺癌软脑膜转移患者中的疗效与安全性评估
Efficacy and Safety Evaluation of Intrathecal Pemetrexed in EGFR-mutated NSCLC Patients with Leptomeningeal Metastases
摘要
Abstract
Background and objective The incidence of leptomeningeal metastasis(LM)in patients with ad-vanced non-small cell lung cancer(NSCLC)is increasing gradually.However,it poses therapeutic challenges due to limited effective interventions.Intrathecal Pemetrexed(IP)holds broad application prospects in the therapeutic domain of LM.This study aims to evaluate the efficacy,safety,and optimal combination strategies of IP in NSCLC-LM patients with epidermal growth factor receptor(EGFR)mutation-positive status,with the aim of providing real-world data support for exploring more precise personalized treatment strategies for these patients.Methods 104 EGFR-mutated NSCLC-LM patients who received IP treatment at Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School from January 2018 to June 2024 were analyzed retrospectively.Clinical parameters,treatment regimens,and survival outcomes were collected.The overall survival(OS),progression-free survival(PFS),clinical response rate and adverse events(AEs)were evaluated.Results The co-hort demonstrated a median PFS of 9.6 months and OS of 13.0 months with 6-month and 1-year OS rates of 80.8％and 56.5％,respectively.Clinical response was observed in 77.9％of patients.The common AEs were myelosuppression(58.7％)and eleva-tion of hepatic aminotransferases(25.0％).Nine(8.7％)patients experienced grade 4 myelosuppression and recovered to nor-mal after receiving symptomatic treatment.Subgroup analyses revealed prolonged OS in patients with Karnofsky performance status(KPS)≥60 versus＜60(14.4 vs 9.0 months,P=0.0022)and those receiving Bevacizumab therapy versus not(19.2 vs 10.5 months,P=0.0011).Conclusion IP exhibits promising efficacy and manageable toxicity in EGFR-mutated NSCLC-LM pa-tients.When combined with Bevacizumab,it exerts synergistic antitumor effects with the potential to further improve clinical outcomes.关键词
肺肿瘤/软脑膜转移/表皮生长因子受体/鞘内注射化疗/培美曲塞Key words
Lung neoplasms/Leptomeningeal metastasis/Epidermal growth factor receptor/Intrathecal chemotherapy/Pemetrexed引用本文复制引用
张田利,陈鑫,蒋澄,林永娟,谢宇,李会颖,尹震宇,俞婷婷..培美曲塞鞘内化疗在EGFR阳性非小细胞肺癌软脑膜转移患者中的疗效与安全性评估[J].中国肺癌杂志,2025,28(8):567-575,9.基金项目
本研究受国家自然科学基金青年科学基金项目(No.82304567)、南京大学医学院附属鼓楼医院临床研究专项资金项目(No.2024-LCYJ-PY-60)及南京大学医学院鼓楼医院新技术发展立项项目(No.XJSFZLX202423)资助 This study was supported by the grants from National Natural Science Foundation of China Young Scientists Fund(No.82304567,to Huiying LI),Clinical Research Funding of Nanjing Drum Tower Hospital(No.2024-LCYJ-PY-60,to Tingting YU)and New Technology Development Project of Nanjing Drum Tower Hospital(No.XJSFZLX202423,to Tingting YU). （No.82304567）
