The Clinical Characteristics And The First-line Chemotherapy For The Optimal Treatment Of Elderly Advanced Non-small Cell Lung Cancer With COPD

Background Chronic obstructive pulmonary disease(COPD)is a common and systemic disease that can be prevented and treated.It is characterized by persistent respiratory symptoms and airflow limitation of limited airflow,caused by toxic gas particles or airway and(or)abnormal alveolar.Primary lung cancer(hereinafter referred to as lung cancer)is one of the major causes of tumor-related death,morbidity and mortality in the first of all kinds of malignant tumors.Non-small cell lung cancer(NSCLC)is the main type of lung cancer,accounting for about 80% of all lung cancer.The studies have shown that chronic airflow obstruction and emphysema increase the risk of lung cancer.50% ~ 70% lung cancer with COPD,and the quality of life in these patients is poor.For a long time.They have been extensively studied as two independent diseases,but its early prevention and treatment and prognosis have not been fundamentally improved.GOLD guidelines state that the treatment regimen for the lung cancer with COPD patients follow the guidelines for lung cancer.The latest NCCN noted that the treatment of lung cancer with COPD is based on the PS score decision.All guidelines did not specifically recommend specific programs for this particular population.There is not yet a unified standard as a guidance for the specific treatment of elderly COPD with advanced non-small cell lung cancer.Part 1.The clinical characteristics of elderly advanced non-small cell lung cancer with COPDObjective To analyze the clinical characteristics of elderly COPD with advanced non-small cell lung cancer(NSCLC),and study the effect of various factors on the prognosis and overall survival of these special populations.Subjects and methods The research object are a total of 140 newly diagnosed elderly COPD with advanced non small cell lung cancer patients,enrolled in the first hospital of Guangzhou Medical University from January 2012 to June 2016.The study retrospectively analyzed the COPD history,pathology type,biopsy,clinical symptoms,TNM stage,PS score,distant metastasis,the basic treatment of lung disease,etc,to further explore the factors affecting the prognosis of patients.Results In a total of 140 patients with COPD combined lung cancer,the average age was68.0±0.8 years.The smoking index of 100 cases> 400,40 cases <400.126 cases of non-small cell lung cancer,14 cases of small cell carcinoma.33 cases of early TNM stage.73 cases of advanced.PS score 2 points or more in 47 cases,including 36 cases of advanced.In a total of 107 patients with advanced,30 cases of distant metastasis.94 patients had received first-line treatment,only 28 cases had received second-line treatment.In 140 follow-up patients,only 48 cases had received inhalation therapy(ICS / LABA)and 92 cases had not received regular inhalation therapy(ICS /LABA).The median survival time(m OS)was higher in the inhaled patients than in the untreated patients(15 months vs 12 months).Cox multivariate survival analysis showed that disease stage,distant metastases,and the the inhalation therapy are independent risk factors affecting the survival time of patient.Conclusion COPD with lung cancer patients are mainly elderly non-small cell lung cancer.They are lack of specific symptoms early,and most of the diagnosis are advanced.In the meantime,it is easy to be ignored basic lung disease treatment.Timely giving these special patients basic disease intervention and the inhalation therapy can effectively improve the quality of life and extend the survival time of patients.Part 2.The first-line chemotherapy for the optimal treatment of elderly advanced non-small cell lung cancer with COPDObjective To investigate the clinical characteristics of elderly COPD complicated with advanced non-small cell lung cancer(NSCLC)and the effect of different chemotherapy regimens on survival.Subjects and methods The research object are newly diagnosed elderly COPD with advanced non small cell lung cancer,enrolled in the first hospital of Guangzhou Medical University from January 2012 to June 2016.According to the first-line treatment program differences are divided into four groups,docetaxel plus cisplatin as DP group(docetaxel 75mg/m2D1,cisplatin,75 mg/m2D1)or gemcitabine plus cisplatin as GP group(1000mg/m2 gemcitabine D1,D8,cisplatin,75 mg/m2D1)or pemetrexed plus cisplatin as PP group(pemetrexed 500mg/m2,cisplatin 75mg/m2D1).All groups were supplemented by antiemetic,hydration and diuretic drug symptomatic support treatment,21 days for a cycle.Symptomatic supportive therapy for the blank control group.The study retrospectively analyzed clinical effectiveness and safety among the four groups.Results In a total of 80 elderly COPD with advanced non-small cell lung cancer,the average age was 66.5 ±0.9 years.There was no significant difference of the age,gender,PS score,TNM staging among groups.The m OS of chemotherapy group was significantly better than the blank control group(13 months vs 5 months).PP group,DP group and GP group m PFS(6months VS 5months VS 5.5months),ORR(34.8%VS33.3%VS 29.2%),m OS(14 months VS 11monthsVS10months),the difference among groups had no statistical significance(P = 0.437,P = 0.942,P = 0.077).The incidence of bone marrow suppression in PP group was lower than that in DP group and GP group(26.1%VS44.4%VS66.7%).There was no significant difference in the incidence of other adverse reactions.The incidence of bone marrow suppression in DP group was much lower than that in GP group,and no statistical difference was found.Conclusion The elderly COPD with advanced non-small cell lung cancer can tolerate chemotherapy.The key is to choose programs.Best supportive care can't allow patients to get enough benefit.For elderly COPD patients with non-scalded NSCLC,the PP regimen should be the preferred first-line chemotherapy regimen.The DP regimen seems to be safer than GP,and the effect is similar.The DP regimen can be used in elderly patients with COPD combined with advanced squamous NSCLC.Part 3.DC intermittent regimen or GC regimen for the treatment of elderly advanced non-small cell lung cancer with COPDObjective To compare the efficacy and safety of docetaxel plus carboplatin intermittent regimen and gemcitabine plus carboplatin for the treatment of elderly advanced non-small cell lung cancer with COPD.Subjects and methods The subjects were the newly diagnosed ?B,? elderly(inoperable,older than60 years old)NSCLC with COPD patients,met the inclusion criteria,enrolled in first Affiliated Hospital of Guangzhou Medical University from June 2015.The patients were randomly divided into two groups: docetaxel 37.5 mg/m2D1,D8,carboplatin AUC 5.0 D1(DC regimen)as the experimental group,gemcitabine 1000 mg/m2,D1,D8,carboplatin AUC 5.0 D1(GC regimen)as the control group.Throughout the trial study,21 days for a chemotherapy cycle,a curative effect evaluation after every two chemotherapy cycles.To study prospectively the difference of efficacy and safety between the two groups.Results Up to the December 2016,20 enrolled patients completed at least two cycles of chemotherapy according to plan with a median of 4 cycles of chemotherapy cycles.All can be evaluated the efficacy.In 9 cases of DC group,PR 3 cases,SD 4 cases,PD2 cases.In 11 cases of GC group,PR 3 cases,SD 5 cases,PD 3 cases.The median survival time of DC group was slightly higher than that of GC group(13 months vs 11months).There was no significant difference between the two groups(P = 0.188).The? ~ ? grade bone marrow inhibition rate of DC group(1/9,11.1%)is much lower than that of GC group,36.4%(5/11),but no statistically significant difference(P =0.095).The ? ~ ? grade bone marrow suppression mainly showed neutropenia.And the liver and kidney toxicity,gastrointestinal adverse reactions in the two groups were no significant difference.The pulmonary function and diffusion capacity of three patients significantly decreased after completion of two courses.The pulmonary function reduced from mild pulmonary ventilation dysfunction to moderate-severe pulmonary ventilation dysfunction,all for GC group.Conclusion The efficacy and safety of docetaxel combined with carboplatin intermittent regimen can be expected.The regimen can be used as a first-line optimization program for elderly patients with COPD combined with advanced NSCLC.