吉西他滨单药/或联合铂类与紫杉类单药/或联合铂类不同顺序治疗晚期肺鳞癌的疗效与安全性

Sequential Treatment of Advanced Squamous Lung Cancer: First-line Gemcitabine +/- platinum Followed by Second-line Taxanes +/- platinum Versus Reverse Sequence

背景与目的吉西他滨和紫杉类药物是晚期肺鳞癌常用的化疗药物,但二者在一、二线治疗中的最佳顺序尚未明确,本研究旨在分析吉西他滨单药/或联合铂类同紫杉类药物单药/或联合铂类在一、二线治疗中不同化疗顺序的疗效及毒副作用。方法回顾性分析了105例IIIb期-IV期肺鳞癌患者,49例为一线予吉西他滨单药/或联合铂类,进展后二线予紫杉类单药/或联合铂类治疗(G-T组);56例为一线予紫杉类单药/或联合铂类,进展后二线予吉西他滨单药/或联合铂类治疗(T-G组)。主要研究终点为总生存(overall survival,OS),次要研究终点为无进展生存期(progression-free survival,PFS)、客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)及不良反应。结果 1G-T组与T-G组中位OS分别为为18.5个月和19.0个月(P=0.520)。2G-T组与T-G组一线化疗中位PFS1分别为5.0个月和4.0个月(P=0.584);两组二线化疗中位PFS2为2.5个月和2.7个月(P=0.432)。3G-T组与T-G组一线化疗ORR1分别为36.73%和33.92%(P=0.577),DCR1分别为79.59%和89.29%(P=0.186);二线化疗ORR2分别为4.08%和5.36%(P=0.085),DCR2分别为51.02%和66.07%(P=0.118)。4G-T组与T-G组毒副作用相似,但G-T组更易出现III级-IV级红细胞减低(P=0.027)和血小板减低(P=0.002)。结论一线吉西他滨单药/或联合铂类序贯二线紫杉类单药/或联合铂类与一线紫杉类单药/或联合铂类序贯二线吉西他滨单药/或联合铂类疗效相当,不良反应可耐受,两种序贯模式均对初治晚期肺鳞癌患者有效。

Background and objective Gemcitabine and taxanes are effective agents commonly used in advanced squamous lung cancer. hTe best treatment sequence, however, is unclear to our knowledge. So we conducted this retrospective study in order to compare the effcacy and toxicities of ifrst-line Gemcitabine＋/-platinum followed by second-line taxanes＋/-platinum with the reverse sequence. Methods We totally analyzed 105 patients with stage IIIb-IV squamous lung cancer in our retrospective study. hTere were 49 patients receiving gemcitabine＋/-platinum ifrst-line followed by taxanes＋/-plati-num second-line （G-T group）, and 56 patients receiving taxanes＋/-platinum ifrst-line followed by gemcitabine＋/-platinum second-line （T-G group）. hTe primary endpoint of the study was overall survival （OS）, and the secondary endpoints included progression-free survival （PFS）, objective response rate （ORR）, disease control rate （DCR） and toxicities. Results hTe me-dian OS were 18.5 mo in G-T group and 19.0 mo in T-G group （P=0.520）. hTe median PFS1 was 5.0 mo and 4.0 mo with ifrst-line gemcitabine＋/-platinum and taxanes＋/-platinum, respectively （P=0.584）. hTe median PFS2 was 2.7 mo and 2.5 mo with second-line gemcitabine＋/-platinum and taxanes＋/-platinum （P=0.432）. hTe ORR1 of G-T group and T-G group were 36.73%and 33.92%（P=0.577）, and DCR1 were 79.59%and 89.29%（P=0.186）;the ORR2 of G-T group and T-G group were 4.08%and 5.36%（P=0.085）, and DCR2 were 51.02%and 66.07%, respectively （P=0.118）. Hematologic toxicities was more frequent in G-T group, the patients experienced more grade 3-4 lower hemoglobin （P=0.027） and thrombocytopenia （P=0.002）. Conclusion hTe effcacy of ifrst line gemcitabine＋/-platinum followed by second line taxanes＋/-platinum and the reverse sequence was similar, and the toxicities was tolerable. Both sequential patterns were effective in advanced squamous lung cancer.