吉西他滨或注射用紫杉醇(白蛋白结合型)联合其他药物一线治疗晚期无基因突变非小细胞肺癌的效果及安全性观察

Observation on the efficacy and safety of gemcitabine or paclitaxel for injection(albumin bound)combined with other drugs in the first-line treatment of advanced non-small cell lung cancer without gene mutation

目的观察吉西他滨或注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗一线治疗晚期无基因突变非小细胞肺癌(NSCLC)的效果及安全性。方法选取四川省成都市第五人民医院2022年1月至2023年6月收治的晚期无基因突变NSCLC患者120例,按照随机数字表法分为对照组和观察组,各60例。对照组予以吉西他滨联合洛铂及卡瑞利珠单抗方案治疗;观察组予以注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗方案治疗。比较2组治疗前及治疗后14 d血清鳞状细胞癌相关抗原(SCC)、细胞角蛋白19片段抗原(CA21-1)、转化生长因子β_(1)(TGF-β_(1))水平,血清CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)水平及CD_(4)^(+)/CD_(8)^(+)比值,比较2组临床疗效及毒副反应发生情况。结果治疗后14 d,2组患者血清SCC、CA21-1、TGF-β_(1)和CD_(8)^(+)水平均低于治疗前且观察组均低于对照组,血清CD_(3)^(+)、CD_(4)^(+)水平及CD_(4)^(+)/CD_(8)^(+)比值均高于治疗前且观察组高于对照组,差异均有统计学意义(均P<0.05)。观察组客观缓解率、疾病控制率均高于对照组[45.0%(27/60)比28.3%(17/60)、73.3%(44/60)比58.3%(35/60)],差异均有统计学意义(均P<0.05)。观察组患者粒细胞减少、血小板减少发生率低于对照组,肌肉/关节痛发生率高于对照组[25.0%(15/60)比78.3%(47/60)、30.0%(18/60)比66.7%(40/60)、71.7%(43/60)比23.3%(14/60)],差异均有统计学意义(均P<0.05),2组间恶心呕吐发生率差异无统计学意义(P>0.05)。结论与吉西他滨联合洛铂及卡瑞利珠单抗相比,注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗一线治疗晚期无基因突变NSCLC不但效果较为显著,可有效降低肿瘤标志物水平,还具有毒性低、对免疫系统影响小、有助于T淋巴细胞亚群恢复、减轻骨髓抑制等优势。

Objective To observe the efficacy and safety of gemcitabine or paclitaxel for injection(albumin bound)combined with lobaplatin and camrelizumab as first-line treatment for advanced non-small cell lung cancer(NSCLC)without gene mutation.Methods Totally 120 patients with advanced NSCLC without gene mutation admitted to Chengdu Fifth People′s Hospital,Sichuan Province from January 2022 to June 2023 were selected.They were divided into control group and observation group using a random number table method,with 60 cases in each group.The control group was treated with gemcitabine combined with lobaplatin and camrelizumab.The observation group was treated with paclitaxel for injection(albumin bound)combined with lobaplatin and camrelizumab.The levels of serum squamous cell carcinoma associated antigen(SCC),cytokeratin 19 fragment antigen(CA21-1),transforming growth factor-β_(1)(TGF-β_(1)),serum CD_(3)^(+),CD_(4)^(+),CD_(8)^(+)and the ratio of CD_(4)^(+)/CD_(8)^(+)were compared between the two groups before and 14 d after treatment.The clinical efficacy and incidence of toxic side effects were compared between the two groups.Results After 14 d of treatment,the levels of SCC,CA21-1 and TGF-β_(1)and CD_(8)^(+)in the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group;the serum levels of CD_(3)^(+),CD_(4)^(+),and the ratio of CD_(4)^(+)/CD_(8)^(+)in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P<0.05).The objective remission rate and disease control rate of the observation group were higher than those of the control group[45.0%(27/60)vs 28.3%(17/60),73.3%(44/60)vs 58.3%(35/60)](both P<0.05).The incidences of granulocytopenia and thrombocytopenia in the observation group were lower than those in the control group,and the incidence of muscle/joint pain was higher than that in the control group[25.0%(15/60)vs 78.3%(47/60),30.0%(18/60)vs 66.7%(40/60),71.7%(43/60)vs 23.3%(14/60)](all P<0.05),and there was no statistically significant difference in the incidence of nausea and vomiting between the two groups(P>0.05).Conclusions Compared with gemcitabine combined with lobaplatin and camrelizumab,paclitaxel for injection(albumin bound)combined with lobaplatin and camrelizumab is more effective in the first-line treatment of advanced NSCLC without gene mutations,which can effectively reduce the level of tumor markers.It also has the advantages of low toxicity,little effect on the immune system,helping the recovery of T lymphocyte subsets,and reducing bone marrow suppression.