Clinical Observation of Pemetrexed for Treating Advanced Non-small Cell Lung Cancer
|School||Dalian Medical University|
|Keywords||non-small cell lung cancer chemotherapy Pemetrexed|
Objective:Pemetrexed as a multi-target antifolate chemotherapeutic drug ,has been widely used in the treatment of advanced non-small cell lung cancer(NSCLC).The purpose of this study was to observe and evaluate the effects and toxicities of pemetrexed in the treatment of advanced non-small cell lung cancer patients. Thus the standard first-and second-line NSCLC chemotherapy to provide more effective treatment basis.Methods:A total of eighty patients with stageⅢB or IV NSCLC were enrolled in this study and all of these patients had been confirmed with pathology or cytology who were admitted to the First Affiliated Hospital of Dalian Medical University from August 2006 to March 2010.Thirty-four of the eighty patients were newly diagnosed who received pemetrexed combined with cisplatin for first-line treatment. And the other forty-six patients were advanced recurrent NSCLC patients received pemetrexed alone for second-line treatment.First-line regimen: Patients received pemetrexed 500mg/m~2 on day 1,and cisplatin 25mg/m~2 on day 1-3 .by intravenous infusion ,with every 21 days as one cycle.Second-line regimen: Patients received pemetrexed 500mg/m~2 on day 1,by intravenous infusion , with every 21 days.All patients who received 2 or more cycles could be evaluated according to RECIST1.1 responce evaluation criteria, and the CTCAE3.0 standard was used to evaluate toxic reaction.The primary end point was effects and toxicities ,the progression-free survival time (PFS) were also analyzed. Quality of life was mainly evaluated by KPS, weight, pain and other changes in patients.Results:In first-line regimen:there was no case with complete response, 15 cases (44.1%)had partial response, 11(32.3%) had stable disease and 8 cases(23.5%) had progressive disease. The objective response rate was 44.1% (15/34).The disease control rate was 76.5%(26/34). 1-year survival rate was 47.1%(16/34),The median survival time was 9.2months.The group comparison shows that age has significant difference in objective response rate (P=0.005),while KPS score has significant difference in objective response and disease control rate(P=0.034;P=0.041),pathology is significant different in disease control rate(P=0.002).The group comparison shows that gender and staging has no significant difference in objective response and disease control rate, while age has no significant difference in objective response rate, pathology has no significant different in disease control rate(P>0.05).In second-line regimen:there was no case with complete response, 5 cases (10.9%)had partial response, 18(39.1%) had stable disease and 23 cases(50.0%) had progressive disease. The objective response rate was 10.9%.The disease control rate was 50.0%. The median survival time was 7.2months. The group comparison shows that staging has significant difference in disease control rate(P=0.000),while gender, age, KPS score and pathology has no significant difference in objective response and disease control rate(P>0.05),staging is significant different in objective response rate (P>0.05).Pemetrexed’s adverse reactions are mildly, The patient can tolerate or take a favorable turn after dealing with to the illness,does not influence the chemotherapy to carry on, and there is no relevant death of chemotherapy.The common adverse effects of the two regimens were hematologic and gastrointestinal toxicity. In the first-line chemotherapy GroupⅢ~Ⅳof white blood cells, platelet,hemoglobin reducing respectively were l3 cases (12.9%), 7 cases (6.9%), 6 patients (5.9%), changes for the better after the G-CSF treatment. The non-hematology toxicity response is light, the main performance for the gastro-intestinal tract responded, the disgusting vomit, escapes sends, the asthenia, the urea nitrogen ascension, the AST ascension, the skin rash and so on, These side effects are less, patients after l~2 week rest and symptomatic treatment can return to normal. Second-line chemotherapy of GroupⅢ~Ⅳagranulocytosis, thrombocytopenia, hemoglobin reduced respectively to 18 cases (10.71%), 13 patients (7.74%), 7 cases (4.17%), take a favorable turn after employing G-CSF treatment.Ⅲ~Ⅳdegree of nausea and vomiting in 5 cases (2.98%), to the symptomatic improvement after treatment,Ⅰ~Ⅱdegree was 53 (31.55%), spontaneous remission after drug withdrawal. Have not seen phlebitis, allergic response and taken off, had illness coming on the example.Mainly for two groups of symptoms to reduce cough, shortness of breath relief, chest tightness, improved pain relief, weight gain and KPS performance status improved. Group of first-line treatment of patients with symptom improvement rate PR and PD patients compared the difference was significant( P = 0.011). Group of second-line treatment of patients with symptom improvement rate PR and PD patients compared the difference was also significant(P = 0.013). These data suggested that symptom improvement rate are related to effect.Conclusion:1、Treatment with pemetrexed combined cisplatin show good clinically efficacy,and with low side effects in the first-line treatment of patients with advanced NSCLC and should be considered a standard treatment option for firstline NSCLC when available.2、Pemetrexed is effective and safe in treating patients with locally advanced or metastatic NSCLC after failure of previous chemotherapy.3、Pemetrexed has the ability of low toxicity, tolerability, safety, to be worthy of clinical application.4、To pemetrexed-based chemotherapy in advanced NSCLC, the most prominent feature is to improve the quality of life.