Forty Cases Clinical Observation Of Gemcitabine Plus Cisplatin In The First-line Treatment Advanced Non-small Cell Lung Cancer

In recent years, lung cancer has become very high incidence and the mortality rate of malignant tumor. Non-small cell lung cancer (NSCLC)accounts for approximately 75% of lung cancer, the 5-year survival rate is insufficient 15%;half of patients had already found belonged to advanced stage and the 5-year survival rate is insufficient 5%. Advanced NSCLC have lost best operation opportunity, extend its surial, improve the clinical symptoms, improve the quality of life of the patients has become the objective of treatment, therefore by combination chemotherapy mainly has become as major palliative treatment. Make a good efficacy of chemotherapy become the primary objective. International large clinical trials ECOG1594 has already proved【gemcitabine plus cisplatin】,【docetaxel plus cisplatin】,【paclitaxel plus cisplatin】and【paclitaxel plus carboplatin】in palliative chemotherapy the response rate is 30% ~ 40%, the response rate and overall survival aspects in these four chemotherapy regimens are no significant statistically differences. But progression-free survival(PFS) of gemcitabine plus cisplatin scheme is longer than three other kinds of schemes.Objective:Retrospective analysis the short-term clinical therapeutic efficacy and toxicity of Gemcitabine(GEM) plus Cisplatin(DDP) in the first-line treatment of advanced stage NSCLC. Explore its application value. Methods:40 patients by cells or pathology were diagnosed as non-small cell lung cancer .Pathologic types for squamous cell carcinoma are 17 cases, adenocarcinoma are 23 cases. According to International Lung Cancer research Association (IASLC) 2009 seventh edition Lung Cancer TNM staging system for clinical stages,Ⅲstage are 18 cases andⅣstage are 22 cases. All can evaluate lesions (via chest CT evaluation lesions). 40 patients Karnofsky scores are 80 points or more , ECOG scores are less than 1 point. Expected patients live more than 3 months. Confirmed without the function damage of hepatic, kidney, heart of the vital organ before treatment. GP scheme according to per square body surface area,for example Gemcitabine ( 1000mg/ m2 ) by intravenous infusion on the first and eighth day,plus Cisplatin(25 mg/m2)on the first to third,every 21days as a cycle.The therapeutic efficacy was evaluated after 2 or more cycles of chemotherapy.Results :Fourty patients are objectively evaluated:complete response(CR)is 0(0%), partial response(PR)is 17(42.5%),stable disease(SD)is 12(30%),progressive disease(PD)is 11(27.5%), response rate(RR)is 42.5%(17/40),disease control rate(DCR)is 72.5%(29/40).Seven patients of PR (clinicalⅢstage)can resect lung lesion after gemcitabine plus cisplatin as first-line chemotherapy.RR of squamous cell carcinoma and adenocarcinoma is respectively 52.9% and 43.2% , RR of squamous cell carcinomas is higher than adenocarcinoma, but by SPSS 17.0 software perform a chi-square (χ2) statistical analysis, P = 0.251, RR in squamous cell carcinoma and adenocarcinoma of GP scheme is not significant statistically.DCR in this study lung squamous cell carcinoma and lung adenocarcinoma is respectively 76.5% and 69.6 % , squamous cell carcinomas slightly higher than adenocarcinoma, but by SPSS 17.0 software perform a chi-square (χ2) statistical analysis, P = 0.900, DCR in squamous cell carcinoma and adenocarcinoma of GP scheme is not significant statistically. The main toxicities are myelosuppressive and gastrointestinal reaction.Ⅲ～Ⅳgrade leucopenia account for 30.0%(12/40);in whichⅠ～Ⅱgrade leucopenia account for 32.5%(13/40);in whichⅢ～Ⅳgrade neutropenia account for 40.0%(16/40),in whichⅠ～Ⅱg rade neutropenia accounted for 22.5%(9/40) .No granulocyte neutropenic fever. Leukocytes and neutropenia can recover in 3 to 7 days via granulocyte colonystimulating factor treatment, and to ensure the safety and sustainability. In whichⅠ～Ⅱanemia account for 7.5%(3/40); in whichⅡthrombocytopenia account for 5.0%(2/40).For thrombocytopenia and anemia only give clinical observation, basic returned to normal after treatment free interval, not impact on subsequent chemotherapy, to ensure the sustainability of chemotherapy. Gastrointestinal reaction,in whichⅢ～Ⅳgrade account for 15.0%(6/40),in whichⅠ～Ⅱaccount for 35.0%( 14/40 ) .Main Clinical symptoms nausea and vomiting,by 5 - hydroxytryptamine receptor antagonists (such as granisetron) and glucocorticoid treatment can relieve.Only 1 patient occursⅡdegree of diarrhea , the diarrhea improved after symptomatic treatment. Withour liver damage, kidney toxicity, neurotoxicity, and phlebitis, no treatment-related death. Conclusion:1.The response rate (RR)of gemcitabine plus cisplatin is 42.5%,disease control rate(DCR)is 72.5%,the curative effect is good. 2.Gemcitabine plus cisplatin as clinicalⅢstage non-small cell lung cancer neoadjuvant chemotherapy.3. The efficacy of Gemcitabine plus cisplatin in squamous cell carcinoma and adenocarcinoma is unrelated,is valid for squamous cell carcinoma and adenocarcinoma.4.The toxicity reaction is light,the patients can tolerate. Do not affect the follow-up treatment, ensure continuity of chemotherapy.5.Gemcitabine plus cisplatin chemotherapy is first choice of first-line treatment of advanced non-small cell lung cancer.