吉西他滨联合铂类治疗晚期非小细胞肺癌的临床分析

Clinical analysis of gemcitabine-platinum combinations in patients with advanced non-small-cell lung cancer

目的评价吉西他滨联合不同铂类化疗药物治疗ⅢB～Ⅳ期非小细胞肺癌（NSCL）的临床疗效和毒副反应。方法45例经细胞学或病理学证实ⅢB～Ⅳ期NSCLC患者（初治35例，复治10例），患者的预计生存时间均超过2个月。按三种方案联合化疗：（1）吉西他滨＋顺铂（GEM／DDP），每3周重复1次；（2）吉西他滨＋卡铂（GEM／CBP），每3周重复1次；（3）吉西他滨＋顺铂（GEM／DDP），每4周重复1次。按美国癌症研究所（NCI）实体瘤疗效评价标准（Recist标准）对目标病灶评价，毒性反应按2007中国肺癌临床指南（NCI—CTCV2．0）标准进行评价。随访患者中位生存时间并计算1年生存率。结果共完成158个周期全身化疗，平均每个病人接受3．5个周期化疗。吉西他滨联合顺铂3周及4周方案、吉西他滨联合卡铂三种方案的有效率分别为45．8％（11／24）、45．5％（5／11）和50％（5／10），总有效率为46．7％（21／45），35例初治患者中有效18例，有效率51．4％，10例复治患者中有效3例，有效率30％。毒副反应主要为白细胞减少、血小板减少、消化道反应、皮疹和搔痒。中位生存时间（MST）为8．9个月，1年生存率为38．7％。结论吉西他滨联合铂类化疗药物治疗晚期NSCL疗效较好，且毒性反应少，耐受性好。

Objective To evaluate the efficacy and toxicity of gemcitabine- platinum combinations in patients with advanced non-small-cell lung cancer （NSCLC）. Methods 45 patients （ chemotherapy-naive and pre-treated cases 35 and 10 respectively） with cytologically or histologically proven stage Ⅲb～Ⅳ NSCLC received gemcitabine-platinum （ cisplatin or carboplatin） combinations. Each regimen was repeated every 3 or 4 weeks. Efficacy was assessed for patients received at least 2 cycles of chemotherapy. Results A total of 158 cycles were completed,all patients were available for evaluating response and toxicity. Response rate （ RR, CR ＋ PR） of gemcitabine/cisplatin（ included 3-week and 4-week regimen） and gemcitabine/carboplatin was 45.8% （11/24） ,45.5% （5/11 ） 50.0% （5/10） respectively, and the overall RR was 46.7% （21/45）. The median survival time was 8.9 months, and the 1 year survival rate was 38.7%. The major toxicities included hematological toxicity, gastrointestinal reactions, skin rash and pruritus. Conclusions Gemcitabine-platinum combinations are valuable and well tolerated in patients with advanced NSCLC, and these 3 regimens can be recommended for more use in the clinical treatment.