Cardiotoxicity Of Pemetrexed And Paclitaxel Respectively Combined With Nedaplatin In Patients With Advanced Non-small Cell Lung Cancer

Objective:Platinum-based two-drug chemotherapy regimens have become the standard first-line treatment regimens for advanced non-small cell lung cancer(NSCLC)chemotherapy.In the combination therapy with platinum drugs,pemetrexed and paclitaxel have been used clinically and have achieved good efficacy.However,the studies related to the efficacy and cardiotoxicity of two chemotherapy regimens,pemetrexed combined with nedaplatin and paclitaxel combined with nedaplatin,in advanced NSCLC are not sufficient.The predictive value of the systemic inflammatory response index(SII),prognostic nutritional index(PNI),and advanced lung cancer inflammation index(ALI)for the cardiotoxicity of chemotherapeutic agents has been studied to a very limited extent.In this study,we retrospectively analyzed the clinical data and related indexes of advanced NSCLC patients applying pemetrexed combined with nedaplatin and paclitaxel combined with nedaplatin,compared and analyzed the efficacy and cardiotoxicity of different chemotherapy regimens in advanced NSCLC patients,and explored the predictive value of SII,PIN and ALI in the cardiotoxicity of chemotherapy drugs,in order to provide an objective basis for the treatment of advanced NSCLC patients.Method:210 patients with a clear diagnosis of advanced non-squamous NSCLC and meeting the inclusion and exclusion criteria who visited our hospital between September 2019 and January 2022 were enrolled and divided into the pemetrexed and paclitaxel groups,with 140 patients in the pemetrexed group and 70 patients in the paclitaxel group.Patients in the pemetrexed group were treated with pemetrexed combined with nedaplatin chemotherapy,and patients in the paclitaxel group were treated with paclitaxel combined with nedaplatin chemotherapy.Patients’ vital signs were closely monitored during chemotherapy,and 2 chemotherapy cycles were used as a phase,according to which chemotherapy cycles were divided into pre-chemotherapy(T0),chemotherapy phase 1(T1),and chemotherapy phase 2(T2).The patients’ general clinical data and indicators of blood routine,liver and kidney function,coagulation routine,cardiac enzyme profile,BNP,echocardiography and ECG at different time points of T0,T1 and T2 were collected,and SII,PNI and ALI were calculated according to the formula.A comparative analysis of the recent efficacy and cardiotoxicity of the two chemotherapy regimens was performed.According to the occurrence of cardiac toxicity,the patients were divided into cardiac toxicity group and non-cardiac toxicity group,and compared and analyzed the blood routine,liver and kidney function,coagulation routine,SII,PNI and ALI in cardiotoxicity group and non-cardiotoxicity group,and analyzed the correlation between SII,PNI and ALI and cardiotoxicity using statistical methods.Results:1.There was no statistically significant difference in basic clinical data such as gender,age,height,weight,blood pressure,heart rate,history of smoking,history of diabetes mellitus,history of hypertension,pathological stage,ECOG score,blood routine,liver and kidney function,and coagulation routine in both groups,P > 0.05.2.The objective remission rate in the pemetrexed group was 23.57% and the disease control rate was 86.43%;the objective remission rate in the paclitaxel group was 21.43% and the disease control rate was 81.43%,which did not show a statistically significant difference,P>0.05.3.There were no patients with abnormal myocardial enzyme profiles in either group at T0.The rate of abnormal myocardial enzyme profile was higher in the paclitaxel group compared with the pemetrexed group at T1 and T2,and the difference was statistically significant,P<0.05.4.The differences in echocardiographic LVEDV,LVESV,LVEF,E/A,and BNP levels between the two groups at T0 did not show statistically significant differences,P>0.05;at T1,BNP levels were higher in the paclitaxel group compared with the pemetrexed group,and E/A decreased compared with the pemetrexed group and the differences were statistically significant,P<0.05;at T2,BNP levels were higher in the paclitaxel group compared with the pemetrexed group and the differences were statistically significant,P<0.05.5.The ECG abnormality rate did not show statistically significant difference between the two groups at T0 and T1,P>0.05.The ECG abnormality rate was higher in the T2 paclitaxel group compared with the pemetrexed group and the difference was statistically significant,P<0.05.6.Comparison and analysis of laboratory tests between the cardiotoxic and non-cardiotoxic groups showed statistically significant differences in total leukocyte count,neutrophil count,platelet count,platelet pressure volume,prealbumin,SII,and PNI between the two groups,P<0.05.7.Multi-factor Logistic regression analysis of the cardiotoxicity group with the non-cardiotoxicity group showed that total leukocyte count,neutrophil count,prealbumin,SII,and PNI were statistically significant at P<0.05 and may be independent risk factors for the development of cardiotoxicity.8.Analysis of the ROC prediction curve showed that the area under the curve for SII predicted cardiotoxicity was 0.694(95% CI: 0.559-0.828,P=0.011),and when the Jorden Index was at its maximum,the corresponding value for SII was643.24,with a sensitivity of 71.40% and a specificity of 64.00%;the area under the curve for PNI predicted cardiotoxicity was 0.654(95% CI: 0.514-0.794,P=0.043),and when the Jorden index was maximal,the PNI corresponded to a value of 39.75,with a sensitivity of 88.00% and a specificity of 42.90%.9.SII was positively correlated with total leukocyte count,monocyte count,neutrophil count,platelet count,and negatively correlated with lymphocyte count,all with statistical significance,P<0.05.PNI was positively correlated with lymphocyte count and albumin,all with statistical significance,P<0.05.Conclusion:1.There is no significant difference in the recent efficacy between pemetrexed combined with nedaplatin and paclitaxel combined with nedaplatin.2.Pemetrexed in combination with nedaplatin is less cardiotoxic than paclitaxel in combination with nedaplatin and may be more appropriate for patients with non-small cell lung cancer combined with cardiovascular disease.3.SII and PNI may become biomarkers to assess the risk of cardiotoxicity in patients with advanced non-small cell lung cancer.