Efficacy Of Etoposide In Combination With Cisplatin Incremental Regimen In Small Cell Lung Cancer

BackgroundSmall cell lung cancer(SCLC)is a poorly differentiated neuroendocrine tumor that accounts for approximately 13%-17%of all lung cancers.The disease is extremely malignant,highly aggressive and highly susceptible to distant metastases in its early stages,with most patients already having advanced metastases at the time of diagnosis and an extremely poor prognosis.Etoposide in combination with cisplatin or carboplatin is the standard regimen for first-line treatment of SCLC.High metastasis and easy drug resistance are two of the most striking features of SCLC.Although the majority of SCLC is very sensitive to chemotherapy,its drug resistance quickly emerges,which in turn leads to tumor recurrence.In addition,cisplatin has more toxic side effects,especially gastrointestinal reactions,which are the dose-limiting toxicity of cisplatin.Gastrointestinal reactions are mainly characterised by acute and delayed nausea and vomiting.Therefore,the selection of effective chemotherapy regimens for SCLC,as well as the prolongation of patient survival and the reduction of chemotherapy toxicity,have become the most pressing clinical issues to be addressed.ObjectiveTo compare the clinical efficacy of classical etoposide combined with cisplatin and etoposide combined with cisplatin incremental regimen in the treatment of SCLC,and to evaluate the effects of the two regimens on patients’ survival,toxic side effects,patients’quality of life,serum tumor markers,and angiogenic markers of chemotherapy drugs,so as to provide theoretical basis for clinical selection of chemotherapy regimens for small cell lung cancer.MethodsSeventy-two patients from the Second Hospital of Shandong University and the Second Hospital of Shandong University Zhaoyuan Branch were collected from July 2018 to December 2020,including 61 cases in the extensive stage and 11 cases in the limited stage,and the study subjects were divided into control and observation groups.This study was approved by the Ethics Committee of the Second Hospital of Shandong University,and all patients had signed the informed consent.The control group was given conventional treatment,etoposide was given intravenously for 1-3 days,the dose was 100mg/m2,and dose of cisplatin was 25 mg/m2.The experimental group was treated with etoposide with cisplatin incremental scheme.The dose of etoposide was 100mg/m2 in 1-3 days,and cisplatin was dose incremental.The dose of cisplatin was 20mg/m2 in the first day,25mg/m2 in the second day,and 30mg/m2 in the third day.The patients in two groups were treated for 21 days per cycle for 4 cycles.After 4 cycles of treatment,prophylactic brain radiotherapy was given to patients with effective chemotherapy and expected survival of>3 months,and radiotherapy was given to those with brain metastases and symptoms.The primary observation:objective response rate(ORR);secondary observations:adverse drug reactions,progression-free survival(PFS),median overall survival(OS),disease control rate(DCR),and disease control rate(DCR).Disease control rate(DCR),quality of life score,and exploratory indicators:serum tumor markers(NSE,proGRP),angiogenic markers(VEGF,CD31).Result1.The ORR was 50.0%in the control group and 75.7%in the observation group,suggesting that the etoposide combined with cisplatin incremental regimen could significantly improve the ORR of SCLC patients when comparing the classical etoposide combined with cisplatin chemotherapy regimen.2.The DCR in the control group was 84.4%,while the DCR in the observation group was 83.8%.There was no difference in DCR between the two chemotherapy regimens in SCLC patients.3.Compared to the classical etoposide combined with cisplatin chemotherapy regimen,the incidence of grade 1-2 vomiting in the chemotherapy cycle was significantly lower in the etoposide combined with cisplatin incremental chemotherapy regimen study subjects,and the difference was statistically significant.There was no statistically significant difference in the incidence of reduced white blood cell count,neutropenia,anaemia,diarrhoea,abnormal liver function,abnormal kidney function and grade 3-4 vomiting in the two study groups during the chemotherapy cycle.4.The median PFS in the control group was 5.10 months and the median OS was 11.90 months;the median PFS in the observation group was 7.60 months and the median OS was 12.10 months.The results suggested that the etoposide combined with cisplatin incremental regimen was able to significantly prolong PFS but not OS in SCLC patients when compared to the classical etoposide combined with cisplatin chemotherapy regimen.5.Patients in the observation group had significantly higher scores on the General Health Status Scale and Functional Scale,and significantly lower scores on the Symptom Scale compared to the control group.Compared to the classical etoposide combined with cisplatin chemotherapy regimen,etoposide combined with cisplatin incremental regimen was able to improve the quality of life of SCLC patients.6.In contrast to classical etoposide combined with cisplatin chemotherapy,etoposide combined with cisplatin incremental regimen significantly reduced the expression of precursor of gastrin-releasing peptide(proGRP)in serum of SCLC patients.The levels of neuron specific enolase(NSE)and vascular endothelial growth factor(VEGF),endothelial cell adhesion molecule-31(CD31),which are markers of tumor angiogenesis,were not affected.Conclusion1.Treatment with etoposide combined with cisplatin incremental regimen can improve the clinical efficacy and objective response rate of SCLC patients compared with the classical etoposide combined with cisplatin regimen.2.Compared with the classical etoposide combined with cisplatin regimen,using etoposide combined with cisplatin incremental regimen for SCLC can reduce the toxic side effects of chemotherapeutic drugs,improve the quality of life of SCLC patients and prolong the disease progression-free survival of patients,with certain safety advantages.3.In comparison with the classical etoposide combined with cisplatin regimen,the use of etoposide combined with cisplatin incremental regimen can reduce the serum tumor marker proGRP level in SCLC patients.