关键词: 非小细胞肺癌, 二线治疗, 化学治疗

Abstract:

Background and purpose: Single drug of docetaxel and pemetrexed as second line treatment is standard treatment of advanced non-small cell lung cancer (NSCLC). Whether combined with platinum can increase the response and survival is still not elucidated. This study was designed to investigate the treatment response, overall survival (OS) and the safety of combined with oxaliplatin or cisplatin regimens as second line in treating NSCLC patients. Methods: Advanced NSCLC inpatients, failure of cisplatin or carboplatin in initial treatment, were divided into three groups at random in 3∶2∶1 rate. Control group: who received docetaxel, 75 mg/m2 (for all patients), d1 or pemetrexed 500 mg/m2 (for non-squamous carcinoma); Cisplatin group: who received cisplatin 25 mg/m2, d1-3 and docetaxel/pemetrexed; Oxaliplatin group: who received oxaliplatin 130 mg/m2 d1 and docetaxel/pemetrexed. Every 3 weeks were repeated as one cycle. The side effect was assessed every cycle and treatment efficacy was investigated every two cycles. Follow-up examination was taken every 3 months after treatment. Results: There were no differences in treatment response, progress free survival (PFS), OS and toxicity among the three groups (P>0.05). Old patients (≥60 years) had a better PFS than that of patients less than 60 years (HR=0.56, 95%CI: 0.35-0.90, P=0.015). Patients with performance score 0-1 had a better PFS and OS (HR=1.52, 95%CI: 1.01-2.30, P=0.048; HR=1.90, 95%CI: 1.17-3.09, P=0.009). Treatment response had relation to PFS and OS (HR=2.93, 95%CI: 2.01-4.26, P=0.000; HR=2.03, 95%CI: 1.37-3.01, P=0.000). Patients with anemia after treatment tended to have a worse PFS and OS (HR=1.59, 95%CI: 0.97-2.61, P=0.066; HR=1.60, 95%CI: 0.94-2.75, P=0.085). Patients with thrombocytopenia after therapy had a worse OS (HR=2.97, 95%CI: 1.01-8.78, P=0.049). Patients with neural toxicity after chemotherapy tended to have a worse PFS (HR=3.36, 95%CI: 0.92-12.25, P=0.066). Patients received post treatment after second line therapy had a better OS (HR=0.36, 95%CI: 0.22-0.61, P=0.000). Conclusion: Combined with oxaliplatin or cisplatin as second line treatment can’t improve the response and survival in NSCLC patient. Treatment response and PS are prognostic factors to NSCLC patients’ PFS and OS. Patients with treatment related anemia might have a worse survival. Post therapy after failure to second line chemotherapy can prolong the survival.

Key words: Non-small cell lung cancer, Second line treatment, Chemotherapy