不同铂类药物联合长春瑞滨治疗晚期非小细胞肺癌临床效果及安全性分析

Effect and safety of different platinum drugs combined with vinorelbine in treating advanced non-small cell lung cancer

目的 探讨顺铂、卡铂及奈达铂分别联合长春瑞滨治疗晚期非小细胞肺癌（NSCLC）的近期疗效和不良反应.方法 纳入92例晚期NSCLC患者,采用简单随机化方法将患者分为顺铂组（34例）、卡铂组（31例）和奈达铂组（27例）,3组分别于第1～3天给予顺铂40 mg/m2、卡铂100 mg/m2和奈达铂40 mg/h2,均于第1、8天给予长春瑞滨30 mg/m2.用药4个周期后评价患者近期疗效和不良反应.结果 完成4个周期化疗患者87例,包括顺铂组32例、卡铂组29例、奈达铂组26例.顺铂组完全缓解2例、部分缓解12例、稳定10例、进展8例,有效率43.8％ （14/32）;卡铂组完全缓解1例、部分缓解12例、稳定10例、进展6例,有效率44.8％ （13/29）;奈达铂组完全缓解2例、部分缓解10例、稳定9例、进展5例,有效率46.2％ （12/26）;3组近期疗效比较差异无统计学意义（P＞0.05）.恶心、呕吐顺铂组最重,卡铂组次之,奈达铂组最轻,3组恶心、呕吐发生率分别为93.8％（30/32）、69.0％（20/29）和38.5％ （10/26）,两两比较差异均有统计学意义（均P＜0.05）.3组白细胞减少发生率分别为35.7％（12/32）、51.7％ （15/29）和30.8％ （8/26）,血小板减少发生率分别为18.8％ （6/32）、27.6％（8/29）和34.6％（9/26）,脱发发生率分别为81.3％ （26/32）、79.3％ （23/29）和80.8％（21/26）,差异均无统计学意义（均P＞0.05）.结论 顺铂、卡铂及奈达铂分别联合长春瑞滨治疗晚期NSCLC近期疗效差异无统计学意义,奈达铂出现恶心、呕吐反应最轻.

Objective To explore the effect and safety of different platinum drugs combined with vinorelbine in treating advanced non-small cell lung cancer （NSCLC）.Methods Totally 92 patients of NSCLC were randomly divided into cisplatin group （34 cases） administrated with cisplatin 40 mg/m2 on the 1st-3rd day,carboplatin group （31 cases） administrated with carboplatin 100 mg/m2 on the 1st-3rd day,and nedaplatin group （27 cases） administrated with nedaplatin 40 mg/m2 on the 1st-3rd day; all the three groups were treated with vinorelbine 30 mg/m2 on the 1 st day and 8th day.The short-term efficacy and adverse reactions were evaluated after 4 cycles of chemotherapy.Results There were 87 cases who completed 4 cycles of chemotherapy,including 32 cases in cisplatin group,29 cases in carboplatin group and 26 cases in nedaplatin group.In cisplatin group,there were 2 of complete response,12 of partial response,10 of stability and 8 of progression,showing an efficacy of 43.8% （14/32） ; in carboplatin group,there were 1 of complete response,12 of partial response,10 of stability and 6 of progression,showing an efficacy of 44.8% （13/29） ; in nedaplatin group there were 2 of complete response,10 of partial response,9 of stability and 5 of progression,showing an efficacy of 46.2% （12/26）.No statistical differences regarding short-term efficacy of chemotherapy were found among the three groups （P 〉 0.05）.The incidence of nausea/vomiting in cisplatin group,carboplatin group and nedaplatin group was 93.8% （30/32）,69.0% （20/29） and 38.5% （10/26）,respectively,showing statistical differences （P 〈 0.05）.In cisplatin group,carboplatin group and nedaplatin group,the incidence of neutropenia was 35.7% （12/32）,51.7% （15/29） and 30.8% （8/26） ; the incidence of thrombocytopenia was 18.8% （6/32）,27.6% （8/29） and 34.6% （9/26）; the incidence of alopecia was 81.3% （26/32）,79.3% （23/29）,and 80.8% （21/26）,showing no statistically differences among the three groups （all P 〉 0.05）.Conclusions The therapeutic effects of cisplatin,carboplatin and nedaplatin combined with vinorelbine are not statistically different in patients with advanced NSCLC,and the gastrointestinal reactions of nedaplatin,such as nausea and vomiting,are the most slight.