多西他赛±铂类二线治疗78例晚期非小细胞肺癌临床观察

Clinical observation of docetaxel combined with or without platinum in the second-line treatment of the 78 patients with advanced non-small cell lung cancer

目的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)是一种常见且预后差的恶性肿瘤,对于驱动基因阴性的晚期患者,首选化疗为主的综合治疗。本研究旨在探讨多西他赛联合铂类化疗对比多西他赛单药二线治疗身体状况评分较好晚期NSCLC的临床疗效和不良反应。方法选取2016-08-03-2018-12-26滨州市人民医院收治的78例驱动基因阴性(表皮生长因子受体、间变性淋巴瘤激酶等野生型)晚期NSCLC患者(Ⅳ期),均能耐受二线化疗。采用回顾性研究方法分为2组,多西他赛单药组(A组):39例,多西他赛75mg/m2,静脉滴入1h,d1。多西他赛联合铂类组(B组):39例,多西他赛75mg/m2,静脉滴入1h,d1;顺铂75mg/m2,静脉滴入,d1或卡铂0.4~0.6g,静脉滴入1h,d1。以上2组均21d为1个治疗周期。比较2组患者无进展生存期(progression-free-survival,PFS)、临床疗效及不良反应。结果治疗2个周期后,A组客观缓解率(objective remission rate,ORR)为7.7%(3/39),疾病控制率(disease control rate,DCR)为33.3%(13/39);B组ORR为12.8%(5/39),DCR为48.7%(19/39)。2组差异无统计学意义(χ^2=0.55,P=0.771;χ^2=1.908,P=0.250),但从DCR上看,B组效果优于A组;同时,B组不良反应发生率在血液学毒性上高于A组,其中粒细胞减少2组之间差异有统计学意义(χ^2=4.482,P=0.034),余差异无统计学意义。A组和B组PFS分别为(3.1±1.5)和(3.4±1.9)个月,Log-rank检验差异无统计学意义,χ^2=0.153,P=0.993。结论多西他赛联合铂类或多西他赛单药均是二线治疗晚期NSCLC安全有效的方法。虽然联合化疗方案相应增加血液系统相关不良反应,但相比单药方案能够提高晚期NSCLC患者二线治疗的ORR和DCR,一定程度延长PFS,且不明显增加化疗相关不良反应,患者耐受性良好。

OBJECTIVE Non-small cell lung cancer(NSCLC)is a common malignant tumor with poor prognosis.For advanced patients with negative driver genes,chemotherapies are preferred.The purpose of our study is to investigate the clinical efficacy and adverse effects of docetaxel combined with platinum chemotherapy compared with docetaxel alone in second-line treatment of advanced NSCLC.METHODS Seventy-eight patients of NSCLC(stageⅣ),who had the negative driver genes,such as,epidermal growth factor receptor,anaplastic lymphoma kinase and other wild gene types were selected from Binzhou People’s Hospital,all of whom were able to accept second-line chemotherapy.The Retrospective study was divided into two groups,group A:docetaxel 75 mg/m2 d1,intravenous drip for 1 h;group B:docetaxel75 mg/m2,d1,cisplatin 75 mg/m2,d1 or carboplatin 0.4-0.6 g,d1,intravenous drip for 1 h.Each of two groups had a21-day treatment cycle.Patients were compared in PFS,clinical efficacy and adverse reaction.RESULTS After two cycles of the treatment,the ORR and DCR of group A were 7.7%(3/39)and 33.3%(13/39).The other group were respectively12.8%(5/39)and 48.7%(19/39).There were no difference(χ^2=0.55,P=0.771;χ^2=1.908,P=0.250).Meanwhile,the incidence of adverse reaction in group B was higher than that in group A in terms of hematological toxicity,and there was a statistically difference between the two groups of granulocytopenia(χ^2=4.482,P=0.034).For the efficacy,the PFS of group A were(3.1±1.5)months,and the other group were(3.4±1.9)months.There were no significant difference in Log-rank(χ^2=0.153,P=0.993).CONCLUSION Both of them are safety and effective as the second-line therapy for advanced NSCLC;although it can also increase the hemopoietic side effects,compared with single-drug,combined chemotherapy can improve ORR and DCR,prolong PFS in a certain extent and would not significantly increase chemotherapy-related toxicity and adverse reaction.