| Objective To compare the clinical efficacy and safety of pemetrexed two sodium(PEM),paclitaxel liposomes(LEP)and best support therapy(BSC)for advanced lung adenocarcinoma with PS=2.Search for the best and effective way to guide clinical treatment.Method 104 patients of advanced lung adenocarcinoma with PS=2 in Fourth Hospital of Qinhuangdao City from Jan.2014 to Dec.2017.All patients were divided into 3 groups.42 patients were treated with LEP 175mg/m2 d1;34 patients were treated with PEM 500 mg/m2 d1;and 28 patients were treated with the best supportive treatment(Intervention and supportive treatments for the clinical symptom caused by cancer).Analyzed and compared the objective remission rate,survival time,safety,and medical costs of the three treatments.The data was analyzed by SPSSl9.0 statistical software.using the chi-square test to compare the rate;survival analysis of the survival curve is plotted using the Kaplan-Meier method;Cox proportional hazards model was used for multivariate analysis.Significance level was 0.05.Results 1 Clinical efficacy: The DCR in the single drug LEP chemotherapy group was 66.7%,and the ORR was 0%;The DCR in the single drug PEM chemotherapy group was 82.4%,and the ORR was 41.2%;The DCR in the best supportive treatment group was 0%,ORR 0%;There was statistically significant difference among the three groups.According to sex,age and smoking stratification,there was statistically significant among groups.2 Survival analysis: The median PFS(95CI)of the single drug LEP,PEM chemotherapy group and the best supportive treatment group were 3.0(2.4 to 3.6)months,5.0(3.9 to 6.1)months and 2.0(2.6 to 3.3)months respectively,There was statistically significant difference among the three groups(χ~2=31.216,P<0.001).After controlling for gender,age and smoking factors,differences still exist.The median OS(95CI)of the single drug LEP,PEM chemotherapy group and the best supportive treatment group were 9.0(7.3 to 10.7)months,15.0(9.3 to 20.7)months and 4.5(3.9 to 5.1)months respectively,There was statistically significant difference among the three groups(χ~2=75.561,P<0.001).After controlling for gender,age and smoking factors,differences still exist.3 Improvement of quality of life: in 104 patients,the quality of life improved in 32 cases,with a total improvement rate of 30.8%.The quality of life of the single drug PEM and LEP chemotherapy groups was 52.9% and 33.3%,respectively.The difference between the two groups was not statistically significant.But the quality of life in the best supportive treatment group was not improved.4 Adverse events: 56 cases(73.7%)had Adverse events during chemotherapy,all of them were grade I-II.Mainly included leukocyte reduction(50%),anemia(65.8%),decreased appetite(65.8%)and fatigue(60.6%).In LEP chemotherapy group,leucocyte reduction and thrombocytopenia(66.7% and 33.3%)were all higher than those in PEM chemotherapy group(29.4% and 5.9%).5 medical expens: The cost of medical treatment in the single drug PEM chemotherapy group was the highest,28 cases exceeded the median medical cost,followed by the best support treatment group,14 cases exceeded the median medical cost,the lowest cost was the single drug LEP chemotherapy group.Conclusion Paclitaxel liposomes alone and pemetrexed disodium alone has a good clinical benefit in patients with advanced lung adenocarcinoma and PS=2,and the chemotherapy tolerance is good.The best supportive treatment can significantly improve the quality of life,reduce the clinical symptoms of patients,and prolong the overall survival time and progression-free survival time.Which can significantly improve the quality of life,as well as reduce patients’ clinical symptoms,extend the overall survival time,and progression-free survival time compared with the best supportive treatment group.The single drug paclitaxel liposome and pemetrexed two have good clinical benefit in the treatment of advanced lung adenocarcinoma of PS=2.The chemotherapy tolerance is good.It can improve the quality of life,prolong the total survival time and the time of no progress. |
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