健择联合卡铂或顺铂治疗晚期非小细胞肺癌

Gemcitabine Plus Carboplatin or Cisplatin in Treatment with Advanced Non-small Cell Lung Cancer

目的观察健择联合卡铂与健择联合顺铂治疗晚期非小细胞肺癌的疗效和毒副反应。方法157例均经病理或细胞学确诊为晚期非小细胞肺癌患者，分为GC和GP两组接受治疗。21天为1周期，每例完成2周期后评价疗效。结果近期疗效C,C组和GP组均无1例完全缓解，部分缓解初冶分别为53．3％、55．8％，复治分别为26．3％、29．2％（P〉0．05）。中位疾病进展时间（MTTP）初治分别为6．4、7．0个月，复治分别为4．8、5．1个月（P〉O．05），中位生存时间分别为8．9、9．3个月（P〉0．05）。一年生存率分别为29．3％、32．7％（P〉0．05）。临床获益改善率为80．3％、64．5％（P〈0．05）。毒副反应以骨髓抑制为主，白细胞、血小板Ⅲ～Ⅳ度毒性发生率GC组较GP组稍高，但两组比较差异无统计学意义（P〉0．05），两组均无出血发生。非血液学毒性主要是胃肠道反应，Ⅲ～Ⅳ度反应GP组多于GC组，两组比较差异有统计学意义（P〈0．005）。结论健择联合卡铂或顺铂治疗晚期NSCLC临床疗效均较高，毒副反应小，安全性高。尤其健择联合卡铂消化道反应轻，临床受益反应好，患者更易接受，对于老年或体力差的晚期NSCLC患者是较理想的治疗方案，临床应用更易推广。

Objective To observe the effect and toxicity of gemcitabine plus carboplatin（GC） and gemcit- abine plus cisplatin（GP） in patients with advanced non-small cell lung cancer（NSCLC）. Methods One hundred and fifty seven patients with histological confirmed NSCLC were enrolled in the study randomly. Twenty-one day for a cycle. Each case was evaluated after two cycles. Results Sixty patients to GC and 50 patients to GP the objective response rate （CR ＋ PR） was 53, 3% vs. 55.8% in the GC and GP as first-line treatment. Fwenty-one patients to GC and 24 patients to GP the objective response rate （CR ＋ PR） was 26. 3% vs 29. 6% in the GC and GP as second-line treatment. The median time to progression was 6. 4 months vs 7. 0 months in the GC and GP as first-line treatment and was 4. 8 months vs 5. 1 months in the GC and GP as second-line treatment arm respectively. The median survival time was 8. 9 moths vs 9. 3 moths and 1-year survival was 29. 3% vs, 32. 7% in the GC and GP group respectively. No significant difference between arms was observed. The clinical benefit rate was 80. 3% vs 64. 5%in the GC and GP arm respectively. There was significantly difference between arms （P〈0. 05）. There was no difference between the arms with hematological toxicity. GP group had a remarkably higher incidence of grade 3-4 nausea/vomiting than GC group（P〈0. 005）. Conclusion GC and GP group provided high ef- fectiveness and safe. However, GC group provided a better overall tolerability and better clinical benefit with GP arm.