Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla 1, 28222, Madrid, Spain.
Clin Transl Oncol. 2013 Aug;15(8):659-64. doi: 10.1007/s12094-012-0989-6. Epub 2013 Jan 29.
Cisplatin plus oral vinorelbine, one of the standard treatments for metastatic non-small-cell lung cancer (NSCLC), is associated with a high rate of neutropenia, and a hemogram is performed on day 8. We analyzed the oncologists' opinions and the result of the hemogram on day 8 to address the question of whether this hemogram could be avoided.
Fifty-eight chemotherapy-naive, advanced NSCLC patients were included. Each received intravenous doses of 75 mg/m(2) cisplatin on day 1 plus oral vinorelbine [60 mg/m(2) in the first cycle (80 mg/m(2) in subsequent cycles) on days 1 and 8], every 3 weeks, for a maximum of six cycles.
Out of 257 cycles analyzed, oral vinorelbine was administered on day 8 in 214 (83.2 %) and the dose was canceled in 6 cycles (2.3 %) due to hematological toxicity. On analyzing the patients to whom chemotherapy had been administered on day 8, based on medical opinion without the doctor knowing the hemogram result, we found that the cycle had been administered with a hemogram showing fewer than 1,500 × 10(6) neutrophils in only 3 of the 185 evaluable cycles [event rate of 1.6 %, with confidence interval 95 % = (0.34-4.67 %)].
The hemogram on day 8 can be avoided and oral vinorelbine administered in relative safety in patients with good performance status, when confirmed by the clinician's perception, thereby making this regimen more comfortable for the patient. This is the first prospective study to examine this issue.
顺铂联合口服长春瑞滨是转移性非小细胞肺癌（NSCLC）的标准治疗方案之一，其相关中性粒细胞减少症的发生率较高，需在第 8 天进行血液检查。我们分析了肿瘤学家的意见和第 8 天的血液检查结果，以确定是否可以避免进行此项血液检查。
共纳入 58 例初治、晚期 NSCLC 患者。所有患者均接受静脉滴注顺铂 75mg/m2，于第 1 天给药，联合口服长春瑞滨[第 1 周期 60mg/m2（随后周期为 80mg/m2），于第 1 天和第 8 天给药]，每 3 周为一个周期，最多进行 6 个周期。
分析了 257 个周期，214 个周期（83.2%）于第 8 天给予了长春瑞滨，6 个周期（2.3%）因血液学毒性而取消了长春瑞滨治疗。分析接受第 8 天化疗的患者，根据医生的意见而不了解血液检查结果，我们发现，在 185 例可评估周期中，仅在 3 例（1.6%，95%置信区间为 0.34%-4.67%）中，血液检查显示中性粒细胞计数<1500×106/L时给予了化疗。
在身体状况良好的患者中，通过临床医生的判断，可避免进行第 8 天的血液检查并相对安全地给予长春瑞滨，从而提高患者的舒适度。这是首个评估该问题的前瞻性研究。
