Influence Of Different Dose-intensity Of Pemetrexed Plus Platinum As The First-line Chemotheraphy In Patiens With Advanced Nonsquamous Non-small Cell Lung Cancer

【Objective】This study aims to analyze the clinical data of pemetrexed combined withcisplatin or carboplatin as the first-line chemotheraphy in patiens with advancednonsquamous non-small cell lung cancer,and evaluate the influence of average relativedose intensity(ARDI) on curative effect and adverse reaction.【Methods】A retrospective analysis of106patinets with stage ⅢB/Ⅳ nonsquamousNSCLC treated at Department of the First Affiliated Hospital of Soochow University fromJanuary2010to June2013. A1l patients received pemetrexed combined with cisplatin orcarboplatin as the first-1ine treatment. The standard dose of pemetrexed was500mg/㎡given every three weeks, Carboplatin dosed to the area under the time-concentration curveof6(AUC=6) and the standard recommended dose of cisplatin was75mg/㎡every threeweeks.Calculated the average relative dose intensity of all chemotherapy drugs incombination chemotherapy and analyze the relationship between ARDI andefficacy,toxicity in advanced nonsquamous NSCLC.【Results】In106patients the objective response rate was23.6%and the disease controlrates was80.2%, the median progression free survival was7months and median survivaltime was15months, one year survival rate was58.8%. The ARDI in the whole group isamong0.73~1.14and the median ARDI was0.93. Patients were divided into three groupsaccording to the ARDI,namely, ARDI <0.9,0.9≤ARDI <1.0and ARDI≥1.0.Thedifferences in objective response rate in the three groups were significant(15.4%vs20.5%vs43.5%, P=0.034), while had no statistically significant differences in disease control rate,median progression free survival, median over survival time and toxicity.But a subgroupanalysis shows the median progression free survival of patients with adenocarcinoma inthree different ARDI was significantly different (P=0.048). In the ARDI-reduced group (ARDI <1.0), out of a total of363treatment courses conducted,15.4%involved treatmentdelays and10.2%involved dose reductions, and the incidence rate of treatment delay wassignificantly higher than that of dose reduction (P=0.045). Hematological toxicity was themain reason for treatment delays.【Conclusion】The ARDI of chemotherapy drugs have an impact on the short-termcurative effect in patients with advanced non squamous NSCLC who received pemetrexedcombined with cisplatin or carboplatin as the first-line chemotherapy,but no obvious effecton the long-term curative effect and adverse reaction. But for the patients with lungadenocarcinoma, ARDI has an impact on the the long-term curative effect. The mainreason for ARDI reduction is treatment delays.