Effectiveness Of Platinum-based Doublets Chemotherapy As First-line Treatment For Advanced Non-small-cell Lung Cancer

Objective: Lung cancer is one of the most common malignant tumor inthe world, its morbidity and mortality are all among the malignant tumors,including Non Small Cell Lung Cancer accounted for about85%of the totalnumber. Because lung cancer symptoms are nonspecific, most patients havebeen in advanced stage, lost the chance of operation, chemotherapy hasbecome the main method for treatment of advanced NSCLC. Platinum basedchemotherapy combined with the third generation of lung cancer is nowstandard first-line treatment for advanced non small cell lung cancerchemotherapy, but the effect is still not satisfactory, increasing the doseintensity can increase efficacy, but adverse reaction increases, make the mostof the patients can’t tolerate. Medical experts to look for drugs with efficacyand tolerability appeared better, pemetrexed provides an option for the clinicaltreatment of. Pemetrexed anti metabolism drugs, its mechanism of action of [7]by blocking the3enzymes thymidylate synthase purine and pyrimidinesynthesis needs thymidylate synthetase, dihydrofolate reductase glycinam ideribonucleotide formyltransferase and glycine ribonucleotide formyltransferasedihydrofolate reductase, the cell division stops at S phase, thus inhibiting thegrowth of tumor cells. People’s attention by more and more because of itsgood tolerance, obvious effect. The study of pemetrexed is applied to theNSCLC first-line chemotherapy efficacy and tolerance are discussed, for theapplication of pemetrexed in NSCLC first-line chemotherapy provide morebasis.Methods: From2009June to2013June in Department of internalmedicine patients breathe Fourth Hospital of Hebei Medical University,confirmed by pathology and89cases of NSCLC patients clear, complete data and PFS. According to the requirements of accurate records of clinical data sointo groups of patients, including sex, age, smoking status, pathological type,clinical stage, clinical efficacy, adverse reactions, etc.. Vein blood collectionby blood analyzer and blood biochemical analyzer were examined with bloodand liver and kidney toxicity, toxicity. Between each chemotherapy adversereaction conditions, disease control rate and the objective efficiency werecompared by χ2test analysis, test for the theoretical frequency of less than5by Fisher’s exact test four data table; analysis of the relationship between thechemotherapy regimen with PFS, using the nonparametric Wilcoxon test, allthe results to P<0.05considered statistically significant. Kaplan-Meier methodwas used to draw the PFS curveResult:1All into a group of objects, male51cases, accounting for57.3%of thetotal cases, female38cases, accounting for42.7%; age range30to86yearsold, the average age was55.5±10.5; aged≥60years in34cases, accountingfor38.2%, age <60years in55cases, accounting for61.8%; smokers in35cases, accounting for39.3%, non smoker in54cases, accounting for60.7%;14cases of patients with TNM stage ⅢB, Ⅳ patients accounted for15.7%,75cases, accounting for84.3%;18cases of squamous cell carcinoma, accountingfor the total number of20.2%cases,71cases of adenocarcinoma, accountedfor79.8%; pemetrexed combined with PP group of19cases, accounting for21.3%, GP group of38cases, accounting for42.7%, TP group of32cases,accounting for36%.2PP group, GP group and TP group, the effective rate were21.1%,15.8%,12.5%. PP group and GP group, TP group objective efficiency of twotwo, P value was1, the difference is not statistically significant; sub groupanalysis: each adenocarcinoma objective comparative efficiency: PP group,GP group and TP group, the objective response rate was21.1%,17.9%,4.2%.PP group and GP group, TP group objective efficiency of two two, Pvalues were more than0.05, had no statistical difference.3PP group, GP group and TP group, disease control rates were68.4%, 57.9%,65.6%. PP group and GP group, TP group of disease control rate,P=0.442,0.838, of GP group and TP group of disease control rate, P=0.508,the difference is not statistically significance. Subgroup analysis, analysis ofthe group of prostate cancer disease control rate: PP group, GP group and TPgroup, disease control rates were68.4%,57.1%,66.7%. PP group and GPgroup, sequoia alcohol combined with TP group, the disease control rate wastwo two, P values were more than0.05, the difference is not statisticallysignificant.4PP group, GP group and TP group, the median PFS was5,6,6months.PP group and TP group, GP group, PFS, P=0.217,0.48, the difference is notstatistically significant; TP group and GP in group PFS, no differencestatistical significance, P=0.808. Subgroup analysis, PFS compared the samebetween the three groups was not statistically significant, P values were morethan0.05.5PP group, GP group and TP group, Ⅱ-Ⅳdegree bone marrowinhibition rates were:26.3%,55.3%,53.1%. PP group and GP group, TPgroup, bone marrow inhibition, P values were0.039,0.038, the difference hasstatistical significance; GP group and TP in bone marrow inhibition ofP=0.934, comparison, no significant differences.6PP group, GP group and TP group, elevated transaminase (more than40U/L) rates were5.3%,34.2%,34.4%. PP group and GP group, TP groupelevated transaminase (more than40U/L) rate, P=0.022,0.020, the differencehas statistical significance; GP group and TP group elevated transaminase(more than40U/L) rate, P=0.988, no significant difference.7PP group, GP group and TP group, nausea, and vomiting were21.1%,57.9%,56.3%. PP group and GP group, TP group, the incidence of nauseavomiting, P values were0.01,0.02, the difference was statistically significant;GP group and TP group nausea, vomiting rate comparison, P=0.89, nosignificant difference.8PP group, GP group and TP group, alopecia was respectively10.5%,53.6%,46.9%. PP group and GP group, TP group, the incidence of hair loss, P value were0.003,0.013, the difference was statistically significant; GP groupand TP group of hair loss occurs rate, P=0.631, no significant difference.Conclusion:1PP GP and TP arms had comparable efficacy as first-line therapy inNSCLC patients with the results of overall response rate:21.1%,15.8%,12.5%respectively.2PP GP and TP arms had comparable efficacy as first-line therapy inNSCLC patients with the results of disease control rates:68.4%,57.9%,65.6%respectively.3No statistical difference was observed in PFS between the PP GP andTP arms as first-line therapy in NSCLC patients.4PP arm was associated with significantly less haematological toxicitythan GP and TP arms as first-line therapy in NSCLC patients.5PP arm was associated with significantly less gastrointestinal adversereaction than GP and TP arms as first-line therapy in NSCLC patients.6PP arm was associated with significantly less alopecia than GP and TParms as first-line therapy in NSCLC patients.