[第三代含铂双药方案用于晚期非小细胞肺癌一线化疗的疗效分析]

[Efficacy analysis of third-generation plus platinum doublets in the first-line chemotherapy of advanced non-small cell lung cancer].

作者信息

Zhao Ling-di, Zhang Xiang-ru, Li Jun-ling, Wang Zi-ping, Wang Yan, Hao Xue-zhi, Hu Xing-sheng, Zhou Sheng-yu, Sun Yan, Shi Yuan-kai

机构信息

Department of Medical Oncology, Cancer Institue/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2012 Jun 12;92(22):1527-31.

PMID:22944054

Abstract

OBJECTIVE

To compare the chemotherapeutic efficacies of third-generation plus platinum doublets in advanced non-small cell lung cancer (NSCLC) patients.

METHODS

A total of 1112 patients were diagnosed as advanced NSCLC at Chinese Academy of Medical Science and Cancer Hospital from January 2005 to August 2009. Their clinical efficacies and regimen compositions were retrospectively analyzed. All calculations were performed by SPSS 17.0.

RESULTS

Differences in objective response rate (ORR) existed among four third-generation agents (paclitaxel, gemcitabine, vinorelbine and docetaxel) plus platinum doublets. Their ORRs were 35.6%, 35.4%, 25.9% and 37.4% respectively (χ(2) = 16.331, P = 0.001). And vinorelbine doublets had the lowest ORR (all P < 0.01). The ORRs of cisplatin and carboplatin doublets were 35.2% and 33.5% respectively. There was no difference in ORR among them (χ(2) = 0.352, P = 0.569). Subgroup analysis showed that the ORRs of four third generation plus platinum doublets were 34.8%, 35.3%, 23.2% and 37.1% in non-agers. And the vinorelbine doublets performed the worst. In the patients with squamous-cell lung cancer, the ORRs of paclitaxel and gemcitabine doublets were 45.5% and 28.4% respectively. And the paclitaxel doublets had the better performance (χ(2) = 5.250, P = 0.026). When combined with carboplatin, the ORRs of four doublets were 36.2%, 16.7%, 15.4% and 32.0% respectively. And the paclitaxel regimen was more effective than the gemcitabine and vinorelbine regimens (P = 0.018 and P = 0.034). The influences of subsequent therapy were nullified when the progression-free survival (PFS) was analyzed. The PFSs of these doublets were (3.67 ± 0.19), (2.95 ± 0.18), (3.05 ± 0.36) and (3.40 ± 0.37) months respectively. There was no difference among them. Pairwise comparisons showed that the mean PFS of patients on paclitaxel doublets was longer than those on gemcitabine doublets. And their PFSs were (3.67 ± 0.19) and (2.95 ± 0.18) months respectively (χ(2) = 7.037, P = 0.008). The PFSs of cisplatin and carboplatin doublets were (3.05 ± 0.14) and (3.65 ± 0.20) months respectively. The patients on carboplatin doublets had a longer PFS than that of those on cisplatin doublets (χ(2) = 6.012, P = 0.014).

CONCLUSIONS

No difference exist in ORRs among different third-generation plus platinum doublets. But as the first-line treatment of advanced NSCLC, carboplatin doublets is superior to cisplatin doublets in terms of PFS.

摘要

目的

比较第三代加铂双药联合方案在晚期非小细胞肺癌（NSCLC）患者中的化疗疗效。

方法

2005年1月至2009年8月在中国医学科学院肿瘤医院共1112例患者被诊断为晚期NSCLC。对其临床疗效和方案组成进行回顾性分析。所有计算均采用SPSS 17.0软件完成。

结果

四种第三代药物（紫杉醇、吉西他滨、长春瑞滨和多西他赛）加铂双药联合方案的客观缓解率（ORR）存在差异。其ORR分别为35.6%、35.4%、25.9%和37.4%（χ² = 16.331，P = 0.001）。长春瑞滨双药联合方案的ORR最低（所有P < 0.01）。顺铂和卡铂双药联合方案的ORR分别为35.2%和33.5%。两者之间的ORR无差异（χ² = 0.352，P = 0.569）。亚组分析显示，四种第三代加铂双药联合方案在非老年患者中的ORR分别为34.8%、35.3%、23.2%和37.1%。长春瑞滨双药联合方案表现最差。在肺鳞状细胞癌患者中，紫杉醇和吉西他滨双药联合方案的ORR分别为45.5%和28.4%。紫杉醇双药联合方案表现更好（χ² = 5.250，P = 0.026）。与卡铂联合时，四种双药联合方案的ORR分别为36.2%、16.7%、15.4%和32.0%。紫杉醇方案比吉西他滨和长春瑞滨方案更有效（P = 0.018和P = 0.034）。分析无进展生存期（PFS）时，后续治疗的影响被消除。这些双药联合方案的PFS分别为（3.67 ± 0.19）、（2.95 ± 0.18）、（3.05 ± 0.36）和（3.40 ± 0.37）个月。它们之间无差异。两两比较显示，紫杉醇双药联合方案患者的平均PFS长于吉西他滨双药联合方案患者。其PFS分别为（3.67 ± 0.19）和（2.95 ± 0.18）个月（χ² = 7.037，P = 0.008）。顺铂和卡铂双药联合方案的PFS分别为（3.05 ± 0.14）和（3.65 ± 0.20）个月。卡铂双药联合方案患者的PFS长于顺铂双药联合方案患者（χ² = 6.012，P = 0.014）。