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The Chemotherapy Efficacy and Prognosis Analysis of Advanced Non Small Cell Lung Cancer

Author: WangQiuMing
Tutor: LinYingCheng
School: Shantou University
Course: Medical Oncology
Keywords: Non-small cell lung cancer Chemotherapy First-line treatment Second-line treatment Prognosis Elderly
CLC: R734.2
Type: Master's thesis
Year: 2011
Downloads: 111
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Abstract

Background and purpose has been shown that third-generation chemotherapeutic agents (vinorelbine, paclitaxel, gemcitabine, docetaxel, pemetrexed) combined with platinum-line treatment of non-small cell lung cancer (Non-small cell lung cancer, NSCLC) of no significant difference in efficacy; docetaxel, pemetrexed, gefitinib and erlotinib are commonly used second-line therapy in non-selected populations also no significant difference in efficacy; chemotherapy plus bevacizumab or Cistercian infliximab can increase the survival rate of a given population, but with the right crowd remains unclear; including programs on pemetrexed in patients with non-squamous cell survival advantage, suggesting selective chemotherapy can bring survival benefit. Single-agent chemotherapy is still a good performance status of elderly patients with advanced NSCLC treatment preferred solution containing platinum combination chemotherapy more effective than monotherapy, but also a corresponding increase in adverse reactions. Chemotherapy in patients with NSCLC explore prognostic factors and predictive markers of efficacy, the implementation of individualized therapy is currently hotspot. This study analyzed retrospectively patients with advanced NSCLC line, second-line chemotherapy, comparing first-line differences in efficacy of programs to explore whether there may be factors that predict the efficacy of chemotherapy and survival prognostic factors, as well as elderly NSCLC double platinum chemotherapy drug related factors. Methods A retrospective analysis in January 2005 - December 2009 Tumor Hospital of Shantou University Medical College admitted to internal medicine, pathology confirmed by histology or non-small cell lung cancer, TNM staging Ⅲ B ~ Ⅳ stage, previously untreated, first-line accept a third-generation chemotherapy (gemcitabine, vinorelbine, paclitaxel, docetaxel) combined with platinum therapy or second-line receiving docetaxel monotherapy in patients with complete clinical data. Using UICC 6th edition TNM staging of lung cancer, according to WHO criteria to evaluate the anti-cancer drug efficacy evaluation efficacy and toxicity, progression-free survival follow-up observation and overall survival. Application of SPSS 17.0 statistical software for statistical analysis, Kaplan-Meier survival analysis method, was used to compare survival between the groups Log-rank analysis; clinical factors between the groups were compared using x2 test, t test was used for continuous variables, which may influence the prognosis related factors using Cox regression multivariate prognostic analysis, with P values ??lt; 0.05 was considered statistically significant. Results 1272 patients with advanced NSCLC clinical features and prognosis of 272 cases of advanced NSCLC analysis showed that the median age of diagnosis 56 years, more men than women (3.1: 1), smokers common (65.8%); adenocarcinoma and squamous cell carcinoma similar proportion (45.2% vs 41.9%); mostly cough, expectoration as the first symptom; common extrapulmonary distant metastases are bone, brain, liver and adrenal glands. Third-generation platinum-based combination chemotherapy first-line treatment of NSCLC total efficiency (RR) 41.9%, disease control rate (DCR) 72.1%, median overall progression-free survival (PFS) and overall survival (OS) were 5.5 months and 11.9 months. Using UICC 7th edition TNM staging of lung cancer can be more accurately distinguish Ⅲ B and Ⅳ prognosis. Multivariate analysis showed that pretreatment prognostic leukocytes and normal LDH levels after chemotherapy tumor control and follow-up treatment of NSCLC patients receiving favorable survival independent prognostic factor. Two first-line advanced NSCLC efficacy of platinum-containing chemotherapy regimens compare different GP regimen (117 cases) and NP regimen (109 cases) first-line treatment of advanced NSCLC efficiency (42.2% vs 42.4%, P = 0.289) and median PFS (6.7 months vs 5.3 months, P = 0.06) had no significant difference, but the GP program has a survival advantage (15.7 months vs 11.9 months, P = 0.007). Subgroup analysis showed that non-squamous patients receiving GP regimen is superior to NP, median PFS (7.5 months vs 4.0 months, P = 0.046) and median OS (16.7 months vs 10.5 months, P = 0.013) were significantly longer; squamous cell carcinoma GP program and NP regimen was no significant difference in median PFS (6.5 months vs 5.9 months, P = 0.700) and median OS (12.7 months vs 11.9 months, P = 0.310) were no significant difference. Evaluated after two cycles of chemotherapy PR or SD to continue the original regimen, its PFS (6.7 months vs 7.7 months, P = 0.891) and OS (15.0 months vs 14.3 months, P = 0.378) were not significantly different. After completion of four cycles of chemotherapy in patients with tumor progression (PR or SD) to continue chemotherapy, either up PR person (PFS: 7.5 months vs 8.7 months, P = 0.752; OS: 17.8 months vs 21.6 months, P = 0.576 ) or SD by (PFS: 7.8 months vs 7.9 months, P = 0.640; OS: 13.9 months vs 15.8 months, P = 0.832) were not significant PFS and OS benefit. 3 advanced NSCLC docetaxel monotherapy efficacy of 71 cases of second-line chemotherapy in advanced NSCLC patients receiving docetaxel second-line chemotherapy, the median number of chemotherapy cycles is 2, the total efficiency of 12.2%, disease control rate of 52.6%; median PFS and OS were was 3.3 months and 7.7 months; 1-year and 2-year survival rates were 25.3% and 5.4% respectively. Common hematologic toxicity, 3 to 4 leukopenia incidence of 11.8%, from 1 to 3 anemia incidence of 43.9%. Multivariate analysis showed that prognosis, ECOG score differential function and multiple distant metastasis in patients with difficult from docetaxel chemotherapy benefit. Four elderly patients with advanced NSCLC efficacy of platinum-containing chemotherapy regimens analyzed 70 cases ≥ 65 years with advanced NSCLC treated with platinum combination chemotherapy, the median number of chemotherapy cycles was 3, the total efficiency of 41.5%, median PFS and OS were 6.0 months and 12.5 months, age lt; 70 years and ≥ 70 years no significant difference in efficacy between patients; 3 to 4 leukopenia incidence of 16.3%, from 1 to 3 the incidence of anemia 53.1%. Multivariate analysis showed that ECOG performance status is poor, the number of distant metastasis and more than three cycles of chemotherapy in elderly advanced NSCLC, platinum-based chemotherapy were independent prognostic factors of poor survival. Conclusion occur in patients with advanced NSCLC in the elderly, more common in male smokers; bone, brain, liver and adrenal gland are common extrapulmonary sites of distant metastases. WBC and LDH levels before treatment, whether the tumor is under control and follow-up treatment is affecting whether to accept an independent prognostic factor in patients with NSCLC. GP regimen and NP regimen efficacy of first-line treatment of advanced NSCLC was no significant difference, but the GP program has a survival advantage; non-squamous cell carcinoma GP regimen is superior to NP, tips histological type can be used as a reference regimen selected; 2 cycles of chemotherapy of PR or SD would be free to continue the original regimen; 4 cycles of chemotherapy, the tumor stabilization controller, there is no significant benefit from prolonged chemotherapy. Docetaxel effective second-line treatment of advanced NSCLC patients is low, blood toxicity common. ECOG performance score difference and multiple distant organ metastasis in patients with difficult from docetaxel chemotherapy benefit. Age is not elderly advanced NSCLC platinum-containing combination chemotherapy absolute contraindication, good functional status, and distant metastasis less in elderly patients, the standard course of platinum-containing combination chemotherapy can significantly improve survival, but common chemotherapy-related toxicity.

The Chemotherapy Efficacy and Prognosis Analysis of Advanced Non Small Cell Lung Cancer

Abstract

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