回顾性分析甲钴胺替代维生素B<sub>12</sub>对培美曲塞进行预处理治疗肺腺癌患者的安全性和有效性

doi:10.3969/j.issn.2095-1264.2024.05.09

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回顾性分析甲钴胺替代维生素B12对培美曲塞进行预处理治疗肺腺癌患者的安全性和有效性
DOI:
                        10.3969/j.issn.2095-1264.2024.05.09
                    
作者:
                        
                        
                    
作者单位:1.宜春学院化学与生物工程学院，江西 宜春，336000;2.南京医科大学附属宿迁市第一人民医院 药学部， 江苏 宿迁，223800;3.南京医科大学康达学院 药学部，江苏 连云港，222000
作者简介:张靖文，女，硕士研究生，研究方向为肿瘤临床药学。
通讯作者:金鑫，男，博士，副主任药师，研究方向为肿瘤临床药学。
中图分类号:R734.2;R969.3
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Retrospective analysis of the safety and efficacy of lung adenocarcinoma patients using mecobalamin in place of vitamin B₁₂ for pemetrexed pretreatment

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Affiliation:

1.College of Chemistry and Bioengineering, Yichun University, Yichun, 336000, Jiangxi, China;2.Department of Pharmacy, Suqian First People's Hospital Affiliated to Nanjing Medical University, Suqian, 223800, Jiangsu, China;3.Department of Pharmacy, Kangda College of Nanjing Medical University, Lianyungang, 222000, Jiangsu, China

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摘要:

目的以单药培美曲塞或培美曲塞联合铂类药物治疗肺腺癌为基础，评价甲钴胺预处理组和维生素B₁₂预处理组的疗效及不良反应，为临床上培美曲塞预处理药物的选择提供依据。方法回顾性分析2018年1月—2020年12月宿迁市第一人民医院使用培美曲塞联合或不联合铂类药物治疗的86例肺腺癌患者的临床资料，根据预处理药物的不同分为维生素B₁₂组（17例）和甲钴胺组（69例）。维生素B₁₂在培美曲塞给药前7天肌肉注射1 000 μg/次，以后每3个周期肌注1次。甲钴胺在培美曲塞给药当天肌肉注射或静脉推注1 000 μg/次或500 μg/次。治疗2个周期后，评价两组患者的疗效和不良反应。结果两组患者的基线水平无显著差异（P>0.05）。维生素B₁₂组患者2周期内的不良反应总发生率为82.4%，未发生3~4级不良反应；甲钴胺组2周期内的不良反应总发生率和3~4级不良反应发生率分别为92.8%和14.5%，组间差异无统计学意义（P>0.05）。甲钴胺组不同剂量（1 000 μg vs. 500 μg）及不同给药方式（肌肉注射vs.静脉推注）的患者2周期内不良反应总发生率、3~4级不良反应发生率和疗效比较，差异均无统计学意义（P>0.05）。维生素B₁₂组疾病控制率（DCR）为94.1%，甲钴胺组DCR为84.1%，差异无统计学意义（P>0.05）。结论在维生素B₁₂缺乏时，可以用甲钴胺替代，对培美曲塞进行预处理，推荐每周期培美曲塞给药当天给予甲钴胺肌肉注射500 μg/次。

Abstract:

Objective To evaluate the efficacy and adverse effects of pretreatment with mecobalamin or vitamin B₁₂ on the base of therapeutic schedule of pemetrexed combined with platinum or not in the treatment of lung adenocarcinoma, and to provide reference for the selection of pemetrexed pretreatment drugs in clinical practice.Methods The clinical data of 86 lung adenocarcinoma patients treated with pemetrexed combined with platinum or not in Suqian First People's Hospital between January 2018 and December 2020 were obtained and retrospectively analyzed. According to different pretreatment drugs, patients were divided into vitamin B₁₂ group (17 cases) and mecobalamin group (69 cases). Vitamin B₁₂ was injected intramuscularly at a dose of 1 000 μg 7 days before pemetrexed administration and every 3 cycles thereafter. Mecobalamin was administered at a dose of 1 000 μg or 500 μg intramuscularly or intravenously on the same day of pemetrexed treatment. After two cycles of treatment, the efficacy and adverse effects of the two groups were evaluated.Results There was no significant difference between the two groups in baseline evaluation (P>0.05). The incidence of the total adverse reactions in vitamin B₁₂ group was 82.4%, and no grade 3~4 adverse reactions were observed in vitamin B₁₂ group. The incidences of total adverse reactions and grade 3~4 adverse reactions were respectively 92.8% and 14.5% in mecobalamin group. There were no significant differences in the incidences of total adverse reactions or grade 3~4 adverse reactions between the two groups within two cycles (P>0.05). In the mecobalamin group, there were no significant differences in the efficacy and the incidences of total adverse reactions or grade 3~4 adverse reactions between patients with different routes of administration (intramuscularly vs. intravenously) or different doses (1 000 μg vs. 500 μg) (P>0.05). The disease control rate （DCR) was 94.1% in the vitamin B₁₂ group, and it was 84.1% in the mecobalamin group. There was no significant difference in the efficacy between the two groups (P>0.05).Conclusion When vitamin B₁₂ is in shortage, mecobalamin can replace vitamin B₁₂ for pretreatment of pemetrexed. It is recommended that mecobalamin is injected intramuscually at a dose of 500 μg on the day of pemetrexed administration in each cycle.