紫杉醇、卡铂方案与异环磷酰胺、鬼臼乙叉甙、卡铂方案治疗晚期非小细胞肺癌的比较

Comparison of Paclitaxel and Carboplatin Versus Ifosfamide,Etoposide,and Carboplatin Regimen for Treatment of Patients withAdvanced Non-Small Cell Lung Cancer

背景及目的:以铂类为基础的联合化疗已证实对晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)患者有益。含卡铂的联合化疗方案与含顺铂者相比,前者虽然有效率稍低,但生存期较长、毒性较低。对于姑息治疗而言,较低的毒性及较长的生存期比有效率更有意义,因此我们选择了以卡铂为基础的联合化疗方案犤紫杉醇、卡铂(PC)与异环磷酰胺、鬼臼乙叉甙、卡铂(IEC)犦治疗晚期NSCLC,并比较这两种方案的疗效和毒性。方法:68例晚期NSCLC患者分别接受PC与IEC化疗,PC方案35例,IEC方案33例。两组病人特征具有可比性(P>0.05)。结果:PC组PR14例,NC19例,PD2例,有效率为40.0%(14/35,95%可信区间犤CI犦:23.8%-56.2%),中位生存期9.1个月(95%CI:7.2-11.0个月),1年生存率为25.7%(95%CI:11.2%-40.2%);IEC组PR7例,NC24例,PD2例,有效率为21.2%(7/33,95%CI:7.3%-35.1%),中位生存期7.8个月(95%CI:6.2-9.4个月),1年生存率为20.0%(95%CI:6.0%-34.0%)。PC组的有效率、中位生存期及1年生存率均优于IEC组,但均无统计学差异(有效率:P=0.094,χ2检验;生存期P=0.684,Log-rank检验)。PC组血液学毒性较IEC组低,其中两组白细胞减少(P<0.0005,秩和检验)及血红蛋白减少(P=0.006,秩和检验)差异有统计学意义;血尿及药物热IEC组较高。

Background and Objective: The platinum containing combination chemotherapy has been proved to be benefit to the patients with advanced non small cell lung cancer. Compared with cisplatin based combination chemotherapy regimens, carboplatin based regimens result in longer survial time and less toxicity, despite of lower response rate. In the palliative treatment setting, less toxicity and longer survial may be more significant than response rate. So we choose the carboplatin based combination chemotherapy regimens as our study objects.To compare the efficacy and toxicity of two carboplatin based combination chemotherapy regimens:paclitaxel and carboplatin regimen(PC) vs ifosfamide, etoposide,and carboplatin regimen(IEC). Methods: Sixty eight patients were enrolled in this study, 35 patients received PC regimen and 33 received IEC regimen. Patients in both groups were well matched with baseline disease characteristics(P >0.05).Results: In PC group, the response rate was 40.0%(14/35,95%confidence interval :23.8%-56.2%)(14 PR, 19 NC, 2 PD). Whereas in group IEC, the response rate was 21.2%(7/33,95%CI:7.3%-35.1%)(7 PR, 24 NC, 2 PD).The median survival and 1 year survival rate were 9.1 months (95%CI:7.2-11.0 months) and 25.7%(95%CI:11.2%-40.2%) for group PC versus 7.8 months (95%CI:6.2-9.4 months) and 20.0%(95%CI:6.0%-34.0%) for group IEC.The better response rate,1 year survival rate, and the longer median survival seen in the group PC were not statistically significant (for response rate, P=0.094, Chi square test; for overall survival, P= 0.684,Log rank test). The hematologic toxicities, especially leukopenia (P< 0.0005, Wilcoxon rank sum test) and anemia (P=0.006, Wilcoxon rank sum test) were less pronounced in group PC; Hematuria and fever were pronounced more in group IEC, whereas allergic reaction was more in group PC, but there were no statistically significant differences between the two groups(P >0.05, Wilcoxon rank sum test); Other toxcicties were similar. Conclusins: Compared with IEC regimen, PC regimen result in less hematologic toxicities in the patients with advanced NSCLC,Although whether its efficacy was better should be confirmed by well controlled randomized clinical trials with more patients.