Optimized Chemotherapy Scheme for Advanced Lung Adenocarcinoma Patients
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摘要: 目的 通过比较不同化疗方案治疗晚期肺腺癌患者的疗效、不良反应、生存情况并分析影响药物疗效的因素，为临床优化选择化疗方案提供依据。方法 回顾性分析141例ⅢB期至Ⅳ期肺腺癌初治患者的临床病例资料，比较培美曲塞+奈达铂、培美曲塞+顺铂/卡铂和三代化疗药+顺铂/卡铂三种一线治疗方案的疗效、不良反应、生存情况，并分析影响药物疗效的因素。结果 （1）药效：培美曲塞+奈达铂、培美曲塞+顺铂/卡铂、三代化疗药+顺铂/卡铂组客观缓解率（objective response rate, ORR）分别为35%、25%、18.52%，疾病控制率（disease control rate, DCR）分别为90%、82.5%、85.19%。三组间ORR、DCR比较，差异无统计学意义（P均＞0.05）。（2）药物疗效影响因素：性别、年龄、吸烟史、有无慢性病、器官转移数目、有无脑转移均不会影响药物DCR。亚组分析三个治疗组间及（培美曲塞+奈达铂）组内比较上述因素下患者的DCR差异均无统计学意义。应用培美曲塞联合铂剂一线治疗晚期肺腺癌患者，EGFR野生组的ORR与DCR分别为28.57%、78.57%；突变组为30.77%、80.77%，差异无统计学意义（P均＞0.05）。（3）不良反应：培美曲塞+奈达铂组白细胞计数减低发生率低于其他两组，差异有统计学意义（P=0.007）。（4）生存分析： 培美曲塞+奈达铂、培美曲塞+顺铂/卡铂、三代化疗药+顺铂/卡铂三组中位无进展生存期（progression free survival，PFS）分别为8、5、7 月。含培美曲塞组间、含顺铂/卡铂组间比较，差异均有统计学意义（P均＜0.05）。结论 培美曲塞+奈达铂方案一线治疗晚期肺腺癌有相对较高的ORR及DCR趋势，中位PFS相对延长，不良反应小，血液学毒性明显减低。性别、年龄、吸烟史、有无慢性病、器官转移数目、有无脑转移等因素均不会影响药物疗效；培美曲塞联合铂剂一线治疗晚期突变型肺腺癌疗效略优于野生型的趋势。临床医师可酌情优选培美曲塞+奈达铂方案对晚期肺腺癌患者进行一线治疗。Abstract: Objective To compare the efficiency and toxicity of different chemotherapy regimens in treating advanced lung adenocarcinoma patients, to analyze the factors affecting drug efficacy and survival of patients, thus to provide better options for clinical treatment of advanced lung adenocarcinoma patients. Methods We reviewed and analyzed the clinical data of 141 hospitalized patients who were diagnosed pathologically as phase ⅢB or Ⅳ lung adenocarcinoma and treated initially. The patients were separated into three groups: Pemetrexed+Nedaplatin group, Pemetrexed+Cisplatin/Carboplatin group and New agent+Cisplatin/ Carboplatin group. After the treatment, we compared the efficiency and toxicity of different chemotherapy regimens, and the factors affecting drug efficacy and survival of patients. Results (1) Drug effects: objective response rates(ORR) of three groups were 35%, 25% and 18.52%; disease control rates(DCR) were 90%, 82.5% and 85.19%, without statistical significance(P>0.05); (2) Influence factors for efficiency of different treatment: The factors: gender, age, smoking history, and with or without chronic diseases, the number of metastasis organs, with or without brain metastasis, didn't affect DCRs of three groups; subgroups analysis showed that DCRs among either the three groups or Pemetrexed+Nedaplain groups made no statistical significance. EGFR wild patients who were treated with Pemetrexed and Platinum had ORR of 28.57% and DCR of 78.58%. The mutation group's ORR and DCR were 30.77% and 80.77%, without statistical significance(P>0.05). (3) Adverse events: Pemetrexed+Nedaplatin group had lower incidence of white blood cell reduction than the other two groups(P=0.007). (4) Survival analysis: The three groups' median progression-free survivals(PFS) were 8, 5 and 7 months. The PFS between each two groups had statistical significance(P<0.05). Conclusion Pemetrexed+Nedaplatin, as the first-line therapy for advanced lung adenocarcinoma patients, has higher ORR and DCR tendency, longer PFS and lower incidence of adverse event, especially in hematological toxicity. The factors: gender, age, smoker, the number of metastasis organs, with or without brain metastasis and with or without chronic disease, will not affect the effect of drugs. EGFR mutation patients have better effects tendency than wild ones who were treated with Pemetrexed and Platinum initially. Clinicians could take Pemetrexed+Nedaplatin as the first-line therapy for lung adenocarcinoma patients.
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Key words:
- Lung adenocarcinoma /
- Pemetrexed /
- Nedaplatin /
- First-line therapy /
- Chemotherapy
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