The Comparison Of Liposomal Paclitaxel And Gemcitabine Plus Cisplatin As First-line Chemotherapy For Advanced Squamous Cell Lung Cancer

Background and objective: Lung cancer is the most common cancer diagnosed over the global and become the leading cause worldwide of cancer-related mortality. Non-small cell lung cancer(NSCLC) accounts for approximately 80%~85% of all lung cancer cases. Squamous cell lung cancer is the second largest NSCLC histological type, just next to adenocarcinoma, for which surgery is the curative treatment. Because it is usually asymptomatic in the early stages, most patients are diagnosed at advanced-stage when operation is not a viable option. For these advanced NSCLC patients whose epidermal growth factor receptor(EGFR) mutations or anaplastic lymphoma kinase(ALK) gene rearrangements were negative, the platinum-based chemotherapy presents the standard management currently. As for squamous cell lung cancer, lymph node metastasis may occur in the early stage, and it is significantly associated with poor prognosis. Compared to ordinary paclitaxel, liposome paclitaxel significantly reduce the hypersensitivity reactions. Meanwhile it’s eliminate half-life is prolonged, drugs distribute more in the lungs, lymph nodes and other tissues rich in reticuloendothelial system in vivo, so it has some target organs. Thus, we speculate that liposome paclitaxel may be associated with certain advantages in the treatment of advanced squamous cell lung cancer with regional or distant lymph node metastasis, but there is still a lack of relevant clinical trial data to con firme it. Therefore, our study aim to evaluate the clinical efficacy and side effect of liposomal paclitaxel and gemcitabine plus cisplatin in the first-line treatment of advanced squamous cell lung cancer, with a view to selecting chemotherapy for squamous cell lung cancer and provide a basis to further clinical studies of chemotherapy.Methods:We collected 71 pathological diagnosis of squamous cell lung cancer with regional lymphatic metastasis patients at our respiratory ward between July 2009 and July 2012, separated into liposomal paclitaxel/cisplatin group(LP) and the gemcitabine/cisplatin group(GP).Medical history and demographic information, including sex, age, ECOG performance status, TNM stage of the tumor are comparable between the two groups.LP group: liposomal paclitaxel 135 to 175 mg/m2 in saline 500 ml iv drip over 3 hours, d1;cisplatin 75 mg/m2 in saline 500 ml iv drip d1. In order to reduce allergic reaction, pretreatment with intravenous dexamethasone(5 to 10mg),intramuscular diphenhydramine(50mg) and intravenous cimetidine(300mg) should be performed 30 minutes before chemotherapy.GP group: gemcitabine 1000 mg/m2 in saline 100 ml iv drip over 30 min d1,d8; cisplatin 75 mg/m2 in saline 500 ml iv drip d1.Two groups use 5-HT3 receptor antagonists to prevent and treat vomiting caused by chemotherapy. Before infusion of cisplatin, at least 1500 ml of saline should be used for hydration both of the two groups. Every 21 days made up of one cycle of chemotherapy. Each patient should complete at least two cycles of chemotherapy. After two cycles of chemotherapy has completed, the efficacy should be evaluated(assessment time not delay more than 1 week). Give the supportive treatment according to the situation of bone marrow suppression caused by chemotherapy,Results:37 patients of the LP group completed 118 cycles of combined chemotherapy in total. 34 patients of the GP group completed 105 cycles of combined chemotherapy in total. In the aspect of lung primary foci,the objective response rate(ORR) is similar between two groups(37.8%vs.32.4%,P=0.629), and the disease control rate(DCR) is also has no statistical difference(83.8% vs.76.5%, P=0.439). In the aspect of regional metastasis lymph node, LP has higher ORR( 45.9%vs.20.6%, P=0.024) and DCR(86.5% vs.64.7%, P=0.032) than GP group. In the aspect of progression free survival(PFS), LP is longer than GP(7.0 vs.5.0 months, P=0.014), but one-year survival rate has no statistical difference between two groups(64.9% vs.52.9%,Χ2=1.043, P=0.307). In the aspect of toxicity of the blood system, LP has much less thrombocytopenia(P=0.007). Furthermore, nausea and emesis side effects is also less in LP(P=0.020).Conclusion: On account of less side effects, higher the ORR and DCR of regional lymph nodes and longer PFS, liposomal paclitaxel plus cisplatin may be superior to gemcitabine plus cisplatin for squamous cell lung cancer with regional lymph metastasis.