Combined with oxaliplatin or cisplatin in second line treatment of advanced non-small cell lung cancer

戴月娣; 张德祥; 郭伟剑; 江联萍; 吴海霞; 张宁; 肖迷

doi:10.3969/j.issn.1007-3969.2014.02.010

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Combined with oxaliplatin or cisplatin in second line treatment of advanced non-small cell lung cancer

更新时间：2025-12-31

- Combined with oxaliplatin or cisplatin in second line treatment of advanced non-small cell lung cancer
- China Oncology Vol. 24, Issue 2, Pages: 139-145(2014)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院闵行分院肿瘤内科,上海
  2. 复旦大学附属中山医院普外科,上海
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2014.02.010
  CLC：
- Published Online：07 March 2014，
  
  Published：07 March 2014
- 稿件说明：
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戴月娣,张德祥,郭伟剑,江联萍,吴海霞,张宁,肖迷. 联合奥沙利铂或顺铂二线治疗晚期非小细胞肺癌的临床研究[J]. 中国癌症杂志, 2014, 24(2): 139-145.

戴月娣, 张德祥, 郭伟剑, et al. Combined with oxaliplatin or cisplatin in second line treatment of advanced non-small cell lung cancer[J]. China Oncology, 2014, 24(2): 139-145.
戴月娣,张德祥,郭伟剑,江联萍,吴海霞,张宁,肖迷. 联合奥沙利铂或顺铂二线治疗晚期非小细胞肺癌的临床研究[J]. 中国癌症杂志, 2014, 24(2): 139-145. DOI： 10.3969/j.issn.1007-3969.2014.02.010.

戴月娣, 张德祥, 郭伟剑, et al. Combined with oxaliplatin or cisplatin in second line treatment of advanced non-small cell lung cancer[J]. China Oncology, 2014, 24(2): 139-145. DOI： 10.3969/j.issn.1007-3969.2014.02.010.

摘要

背景与目的：晚期非小细胞肺癌(non-small cell lung cancer，NSCLC)二线化疗可选择单药多西他赛或培美曲塞，联合铂类能否提高疗效及延长生存尚不明确。本研究比较单药多西他赛或培美曲塞与联合奥沙利铂或顺铂方案二线治疗晚期NSCLC近期疗效、生存期和安全性。方法：经一线联合顺铂或卡铂治疗失败的121例晚期NSCLC患者按3∶2∶1比例随机分组，对照组(n=56)：多西他赛75 mg/m2(所有肺癌)或培美曲塞500 mg/m2(非鳞癌)，第1天；顺铂组(n=45)：顺铂25 mg/m2，第1~3天联合多西他赛或培美曲塞；奥沙利铂组(n=20)：奥沙利铂130 mg/m2，第1天联合多西他赛或培美曲塞。3周为1个周期，治疗每个周期评价不良反应，每2个周期评价疗效，回访生存期。结果：3组的治疗疾病反应率、无进展生存期(progression free survival，PFS)、总生存期(overall survival，OS)及不良反应差异均无统计学意义(P＞0.05)。≥60岁老年患者较＜60岁患者PFS更长(HR=0.56，95%CI：0.35~0.90，P=0.015)；PS评分0~1分患者PFS和OS更长(HR=1.52，95%CI：1.01~2.30，P=0.048；HR=1.90，95%CI：1.17~3.09，P=0.009)。治疗反应率与PFS和OS相关(HR=2.93，95%CI：2.01~4.26，P=0.000；HR=2.03，95%CI：1.37~3.01，P=0.000)。化疗后发生贫血患者PFS和OS呈缩短趋势(HR=1.59，95%CI：0.97~2.61，P=0.066；HR=1.60，95%CI：0.94~2.75，P=0.085)，血小板减少患者OS更短(HR=2.97，95%CI：1.01~8.78，P=0.049)。有神经毒性患者PFS呈缩短趋势(HR=3.36，95%CI：0.92~12.25，P=0.066)。二线治疗失败后接受后续治疗者OS有获益(HR=0.36，95%CI：0.22~0.61，P=0.000)。结论：二线联合奥沙利铂或顺铂治疗NSCLC患者疗效和生存期无提高。疾病反应、PS评分与PFS及OS相关，治疗后发生贫血、血小板减少、神经毒性患者预后可能更差。二线治疗失败后接受后续治疗能延长生存期。

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 (P0.05). 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.

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