Therapeutic Analysis Of Pemetrexed Combined With Cisplatin First-line Chemotherapy In The Treatment Of Advanced Lung Adenocarcinoma In The Elderly

Background:Lung cancer is one of the major global health problem,which is the highest rate of cancer diagnosis in the global cancer statistics,the incidence of cancer accounted for 13%,is the world’s men and women in developed countries with the highest mortality rate of cancer.The mortality of women in developing countries,after only in breast cancer.Although new drugs and ideas emerge in an endless stream,but the lung cancer 5 year survival rate is still hovering around 15%.In China,lung cancer deaths accounted for cancer deaths in 24.41%,55 years of age,the higher mortality rate in patients with lung cancer,it has become a malignant tumor with the highest mortality rate.China non-small cell lung cancer(no small cell lung cancer,NSCLC)for the pathological type of lung cancer 80%-85%among them,adenocarcinoma,has been replaced by squamous cell carcinoma,lung cancer has become the most common type,effectively improve the overall survival of these patients(overall,survival,OS),which is expected to improve the patients with lung cancer The survival of the status quo.At present,the third generation of platinum based chemotherapy is the standard first-line chemotherapy in patients with advanced NSCLC.But most of the elderly patients with NSCLC complicated with cardiovascular and endocrine system diseases,combined with the body reserve function decline,poor tolerance to chemotherapy;pemetrexed as a new target of anticancer drugs,has the advantages of low toxicity,high efficiency and wide antitumor effect.Objective:On the basis of medical treatment of elderly patients with late lung cancer,the main is to further study the combination of chemotherapy drugs on the treatment of elderly patients with advanced lung adenocarcinoma.In different groups of patients were treated with pemetrexed combined with cisplatin and docetaxel combined with cisplatin,were observed in the two drug combination of cisplatin in the treatment of senile patients with advanced lung adenocarcinoma.Toxicity and safety,statistical analysis,which can make clear benefit in these patients.Methods:From June 2013 to January 2017 were retrospectively analyzed in our hospital treatment of 80 cases of elderly patients with advanced lung adenocarcinoma were randomly divided into pemetrexed plus cisplatin group 41 cases,docetaxel plus cisplatin group.39 cases of pemetrexed plus cisplatin chemotherapy scheme:1 weeks ago,Folic Acid Tablets began to accept Oral Beauty Culture pemetrexed chemotherapy in patients with 400 g/d,until the end of the treatment,that is the end of the 21 day period;1 weeks before chemotherapy given VitB12 1000 g/intramuscular injection,injection 1 times every 21 days;1 days before chemotherapy,the day and second day oral dexamethasone 4mg,bid,and prevention of skin rash the incidence of allergy.Given pemetrexed:500mg/m 2,first days of intravenous cisplatin:70mg/m2,first days intravenously;every 21 days for 1 cycles.Docetaxel plus cisplatin group:1 days before chemotherapy,the day and second day oral dexamethasone 8mg,bid,75mg/.M 2,first day,first day cisplatin:7μmg/m2,intravenous drip;every 21 days for 1 cycles.The prevention measures such as chemotherapy antiemetic process,24 hours after the end of chemotherapy if white blood cells reduce Ⅱ degrees,to the leukogenic treatment.Blood tests 1 weeks before chemotherapy was 1 times tumor markers and biochemical indexes,efficacy evaluation after 2 cycles of imaging.Results:Efficacy and survival:pemetrexed plus platinum group RR 25.4%,DCR 63.7%;docetaxel plus platinum group RR 19.7%,DCR 63.8%.two RR group compared with DCR P,0.05,the difference was not statistically significant.All patients were followed up for 6-24 months,median follow-up October.The pemetrexed plus platinum group TTP for 3.1 months,MST was 8.6 months,1 year survival rate was 31.2%;the West he Senegal platinum group TTP 3.5 months,MST was 9.1 months,1 year survival rate for 38.4%.patients in the two groups of TTP,MST,the 1 year survival rate is no difference have statistical significance.Adverse reactions:two groups of patients with adverse reactions mainly have nausea and vomiting,constipation,diarrhea,myelosuppression,fatigue,insomnia,hair loss,skin rash and liver function damage.The adverse reaction specific table 2.pemetrexed plus platinum group nausea and vomiting,constipation,diarrhea,anemia,bone marrow suppression(neutropenia,fatigue,alopecia)the adverse reactions weredocetaxel group,the difference was statistically significant(P<0.05),but there is no significant difference between the two groups and other adverse reactions.Analysis of prognostic factors:Cox multi factor analysis to determine the factors affecting the overall survival of patients showed that patients with ECOG score,TTP,clinical stage and treatment effectiveness were independent risk factors for survival of patients(P<0.05),while age,gender,smoking has little overall survival relationship with patients.Conclusion:For elderly patients with advanced lung adenocarcinoma with pemetrexed combined with cisplatin and docetaxel combined with cisplatin chemotherapy group have similar effects,but the pemetrexed combined with cisplatin group side more West combined withcisplatin was low.His race was generally well tolerated.