| OBJECTIVE:Lung cancer is the major cancer which threatens human lives all over the world. Among the common malignancies in the cities, lung cancer is the leading cancer type calculated both in incidence and mortality. Besides, the incidence of lung cancer is increasing year by year; the 5-year surviving rate for lung cancer is only about 10%.80%～85% of all the lung cancer patients get non-small cell lung cancer (NSCLC). Currently, the trend offor lung curing cancer treatment is mainly using the comprehensive treatment therapy combining of surgery, radiotherapy, chemotherapy, biology, and other kinds of treatments. As the symptoms of early lung cancer are not obvious, about 70%～80% of patients have lost the chance of operation when they try to get cured after discovering the symptoms. Chemotherapy is very important in lung cancer treatment, especially in the cases ofⅢ/Ⅳgrade non-small cell lung cancer, for which chemotherapy is the main treatment. Recently, platinum based treatment combining another two drugs is recommended to as the standard regimen cure inⅢ/Ⅳgrade non-small cell lung cancer treatment. Also, based on the Platinum medicines, the chemotherapy of NSCLC treatments are called to cure advanced non-small cell lung cancer. This thesis systematically reviews the clinical efficacy, toxicity and economic effects of three common regimen used in NSCLC chemotherapy:GP (gemcitabine+platinum), NP (vinorelbine+platinum) and TP (docetaxel+platinum) regimens.Materials and methods:By virtue of pathology and cytology, the Department of Chemotherapy in Qilu Hospital of Shandong University had accurately identified 88 cases of terminal (stageⅢ-stageⅣ) non-small cell lung cancers from January 2005 to December 2009. All of the patients have not received surgeries yet, and there do exist comparable tumors by the technology of computerized tomography (CT). The patients are divided into 3 groups; each group is subjected to treatment with one of the three chemotherapy regimens (GP, NP and DP). Every 21 days is set as a treating period, and after two periods of chemotherapy, each patient is subjected to CT analysis in order to evaluate the treating effects. In addition, it is essential to analyze the side effects caused by the previous three groups of chemo regimens, the corresponding therapy and response. At the same time, analyzing the previous three cases by using the economics method of "cost-effect" is a good choice. Chi-square is used for statistics, and for the expenses, rank test is used. P<0.05 is considered to be statistically significant.Result:According to the evaluations of 88 patients who use GP regimens (32 cases), NP regimen (35 cases) and DP regimen (23 cases) after 2 chemotherapy cycles, the efficiency of GP is 40%, for NP it is 42.9% and for DP it is 47.8%.There is no significant difference in clinical curative efficacy (P>0.05).The main side-effect is bone marrow inhibition, of which the percent of NP is 85.7%(30/35),higher than GP regimen and DP regimen. ForⅢ/Ⅳdegree white blood cell inhibition, the incidence for NP regimen is 42.9%(15/35), much higher than the other two groups. But for the platelet inhibition, GP regimen is higher than NP and DP regimen. Secondly, for gastrointestinal side-effects, GP regimen is higher than NP and DP regimens. Besides, in the appearance rate of rash, GP scheme is 23.3%(7/30); in the alopecia situation, DP regimen (approximately 98%) is higher than the other two groups; phlebitis neural is comparably obvious in NP group. For the other side-effects such as abnormal liver function, the three regimens has similar appearance rate. After analyzing the average chemotherapy cost and efficient ratio, we can come to the conclusion that NP regimen is the most economical scheme, followed by DP regimen.Conclusion:After analyzing the clinical data from the 88 non-small cell lung cancer patients subjected to chemotherapy in our department, it's concluded that NP, GP and TP regimens has similar short-term curative effect without significant differences detected among the three groups (P>0.05). But for the patients whose tumor progressed after treatment and patients who can not tolerate the chemotherapy side-effects after the first two periods of treatment, each regimen still have certain curative effects as second-line choices. Though the platinum-based two drugs regimens showed some differences in adverse reactions, no obvious advantage is observed among the three chemotherapy regimens. However, NP regimen is found to be the most economical and effective one when we only take cost and efficiency into consideration,... |
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