Wang Chun, Zhou Lin, Liu Yong-mei, Ding Zhen-Yu
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2013 Jul;44(4):685-8.
Given controversy remains on monotherapy and combinatory chemotherapy in elderly patients (> or = 70 years) with advanced non-small cell lung cancer (NSCLC), we conducted this study to compare the safety and efficacy of liposome paclitaxel and platinum-containing doublets.
From January 2007 to March 2009, totally 65 patients (age > or = 70 years) with pathologically confirmed NSCLC were enrolled. 33 patients received liposome paclitaxel monotherapy (monotherapy group) and 32 patients received platinum-containing doublets chemotherapy (combinatory group).
No CR was observed in all patients. Both groups had similar objective response rate (ORR) (6.1% vs. 15.6%, P = 0.399). However, a statistically significant higher disease control rate (DCR) (65. 6%) was observed in he combinatory group when compared with that of monotherapy group (39.4%, P = 0.034). The combinatory group had longer time-to-progression (TTP) (94 days, 95% CI: 60-127 days) than the monotherapy group (51 days, 95% CI: 22-79 days, P = 0.046). The median overall survival days in the combinatory group was 524 days (95% CI: 146-901 days) where as in the monotherapy group only 146 days (95% CI 32-259 days) (P = 0.001). The most common adverse reactions were myelosuppression, gastrointestinal reactions and elevated transaminase in the monotherapy group, while those were myelosuppression, gastrointestinal reactions and infection in the combinatory group. Generally there was no significant difference in the adverse reaction, except grade 3-4 thrombocytopenia (P = 0.004). It should be addressed that 1 patient (3.0%) in the monotherapy group had an onset of severe infection, while the number rose to 5 (15.6%) in the combinatory group (P = 0.079).
Platinum-containing doublet chemotherapy achieved a higher response rate, longer time-to-progression and overall survival compared with liposome paclitaxel monotherapy in the treatment of elderly patients with advanced NSCLC. However thrombocytopenia and severe infection should be monitored for the combinatory chemotherapy.
鉴于老年（≥70岁）晚期非小细胞肺癌（NSCLC）患者采用单药治疗和联合化疗仍存在争议，我们开展本研究以比较脂质体紫杉醇与含铂双联化疗方案的安全性和疗效。
2007年1月至2009年3月，共纳入65例经病理确诊的NSCLC患者（年龄≥70岁）。33例患者接受脂质体紫杉醇单药治疗（单药治疗组），32例患者接受含铂双联化疗（联合治疗组）。
所有患者均未观察到完全缓解（CR）。两组的客观缓解率（ORR）相似（6.1%对15.6%，P = 0.399）。然而，联合治疗组的疾病控制率（DCR）（65.6%）显著高于单药治疗组（39.4%，P = 0.034）。联合治疗组的疾病进展时间（TTP）更长（94天，95%CI：60 - 127天），而单药治疗组为51天（95%CI：22 - 79天，P = 0.046）。联合治疗组的中位总生存天数为524天（95%CI：146 - 901天），而单药治疗组仅为146天（95%CI：32 - 259天）（P = 0.001）。单药治疗组最常见的不良反应为骨髓抑制、胃肠道反应和转氨酶升高，而联合治疗组为骨髓抑制、胃肠道反应和感染。总体而言，除3 - 4级血小板减少外（P = 0.004），不良反应无显著差异。需要指出的是，单药治疗组有1例患者（3.0%）发生严重感染，而联合治疗组这一数字升至5例（15.6%）（P = 0.079）。
在治疗老年晚期NSCLC患者时，含铂双联化疗与脂质体紫杉醇单药治疗相比，缓解率更高，疾病进展时间和总生存期更长。然而，联合化疗时应监测血小板减少和严重感染情况。
