| BackgroundLung cancer, the mortality rate of which is the highest among cancer-related mortality in the world, has become the malignant tumor with the fastest growth in morbidity and mortality in China. Its mortality rate in our country increases every year, by1.63%by average. Because of early symptoms of lung cancer lacking specificity, around70%-80%of patients with lung cancer are in a advanced stage (clinical stage ⅢB/Ⅳ) when diagnosed, and only20%-30%patients are under good conditions to accept an operation; in addition, local therapy is inadequate for many patients. Twenty years ago, local therapy was believed to be the main therapeutic approach to squamous-cell lung cancer, whereas chemotherapy was not considered for most patients with squamous-cell lung cancer. Also, Lung cancer onset appears rather insidiously during its early stage so that most patients are already in the terminal stage (stage ⅢB/Ⅳ) of cancer when they accept diagnosis, thus missing opportunity for operation. The treatment to inchoate and local advanced cancer is similar to that for other NSCLC, however, the standard treatment to advanced squamous-cell lung cancer is still by using cytotoxic drugs. Currently the combination chemotherapy with cisplatin plus gemcitabine is one of the main chemotherapies, but the efficacy of chemotherapy is considerably low and its improvement has encountered a bottleneck. In recent years, new cancer treatment drugs like EGFR-TKI, antifolate drug pemetrexed, anti-angiogenesis drug bevacizumab, etc., have continued to crowd into clinic, nevertheless, majority of the target population are non-NSCLC patients and the treatment to squamous-cell lung cancer has come to a halt. At present, there is no good target therapy to squamou-cell lung cancer, with survival rate lower than glandular cancer, and chemotherapy is still the standard therapy to advanced squamous-cell lung cancer. Endostar, a new kind of human endostatin independently developed by Chinese researchers, can act specifically on endothelial cells, especially those of micrangium and starve tumors of nutrient supply by inhibiting anigogenesis of tumor, thus accelerating the process of apoptosis. It is found by stage III clinical lung cancer research that, endostar combined with chemotherapy to treat advanced NSCLC can increase the objective response rate, prolong patients’life and improve their live quality.ObjectiveTo observe the efficacy and adverse reactions of first-line treatment to advanced squamous-cell lung cancer by continuous intravenous pumping rhendostatin injection (endostar) combined with GP(gemcitabine plus cisplatin)MethodsFifty-nine Patients pathologically diagnosed with stage Ⅲb/Ⅳ squamous-cell lung cancer were randomly divided into experimental group (N=31, intravenous pumping of endostar combined with GP) and control group (N=28, GP). Every3weeks constitute one cycle and efficacy is evaluated every2cycles. Both groups were treated with GP regimen and53patients complete2cycles at least. The treatment results and toxicity were evaluated according to the RESIST1.1criteria. The KPS scores were used to evaluate the quality of lift, and toxicity were evaluated according to WHO criteria. Results1. Of experimental group, the effective rate (ER) is51.9%(14/27), and the disease control rate (DCR)81.5%(22/27); while ER and DCR of control group are respectively34.6%(9/26) and73.1%(19/26). Of experimental group, the effective rate (ER) is51.9%(14/27), and the disease control rate (DCR)81.5%(22/27); while ER and DCR of control group are respectively34.6%(9/26) and73.1%(19/26). Short-terms effects show a17.3%increase of objective ER by endostar combination with GP against GP, but without statistical significance (P>0.05).2. Median TTPs of experimental and control groups are8.3months and6.5months, respectively. TTP of experimental group is1.8months longer than that of control group, showing statistical significance (P<0.05).3. The earlier tumor stage at which patients received therapy, the better curative effect. PFS of patients receiving therapy at IIIB stage increased largely by about5.7months compared to that of patients receiving therapy at IV stage, also with statistical significance.4. Positive correlation existed between treatment cycle and TTP.50%TTPs of squamous-cell lung cancer treated for2weeks,4weeks, and6weeks above, are4.2months,6.5months, and9.5months respectively, showing difference with statistical significance (P<0.05).5.Incidence rate of adverse reactions of both groups are similar. Incidence rate of n ausea and vomitting (experimental group16.67%, control group22.64%), incidence ra te of hematologic toxicity (experimental group36.67%, control group38.46%), and inci dence rate of cardiovascular toxicity (experimental group3.33%, control group0%) sho w no statistical significance between experimental and control groups (P>0.05).Endost ar combined with GP showed no appreciable increase in toxicity and side effects, and had tolerance.ConclusionContinuous intravenous pumping of endostar combined with GP regimen for the patients with advanced squamous-cell lung cancer was effective and has lower adverse reaction. |
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