| Background and Objective: Systemic chemotherapy is the main treatment for advanced non-small cell lung cancer. A lot of clinical trials have showed that systemic chemotherapy can prolong survival time and improve quality of life. The standard treatment for advanced NSCLC is platinum plus one new drug chemotherapy regime. Clinical researches have suggested that docetaxel or gemcitabine plus platinum has slight advantage,but the researches have not furtherly suggested which is better. In order to explore more effective chemotherapy regime with less toxicity, better tolerance and patients'willingness to accept,we observed and compared the clinical efficacy and toxicity of docetaxel plus carboplatin (DC) and gemcitabine plus carboplatin (GC);and in order to eplore populations with certain advantage,we compared the clinical efficacy from initial/re-treated treatment,different pathology type,period and ECOG score.Materials and Methods: 59 inoperable patients with stageâ…¢b/â…£confirmed NSCLC by pathology or cytology. DC group had 30 patients, 19 males and 11 females;patients were between the age of 35 and 69 years old, the median age was 55 years old; 8 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, 2 cases of alveolar carcinoma,1 case of large cell carcinoma, 1 case of adenosquamous carcinoma, 3 cases unidentified but confirmed NSCLC; ECOG score:2 cases with 0, 18 cases with 1, 10 cases with 2; 17 cases with stageâ…¢b, 13 cases with stageâ…£; 23 cases accepted initial treatment, 7 cases accepted retreatment. GC group had 29 cases, 20 males and 9 females;patients were between the age of 35 and 69 years old, the median age was 59 years old;10 cases of squamous cell carcinoma, 13 cases of adenocarcinoma , 2 cases of alveolar carcinoma, 1 case of large cell carcinoma, 3 cases unidentified but confirmed NSCLC; ECOG score:3 cases with 0, 18 cases with 1,8 cases with 2;15 cases with stageâ…¢b, 14 cases with stageâ…£; 23 cases accepted initial treatment, 6 cases accepted retreatment. Patients in DC group were given docetaxel with 75 mg/m~2, intravenous drip, first day; carboplatin with AUC5 (300 ~ 400mg/m~2), intravenous drip first day. Patients in GC group were given gemcitabine with 1.0 g/m~2, intravenous drip, 1st,8th day; carboplatin with AUC 5 (300 ~ 400mg/m~2), intravenous drip, first day . The patients were given drugs every 4 weeks(one cycle), each patient was given at least two chemotherapy cycles. we evaluated the patients after 2 cycles of chemotherapy .According to the evaluation criteria of WHO, the patients were divided into CR (complete remission), PR (partial remission), SD (stable disease), PD (progressive disease). According to toxicity criteria of WHO ,the toxicity were divided into 0 -â…£, kept records when adverse events happened.Results:1,59 patients had completed 207 chemotherapy cycles, with the average of 3.5 cycles every patient.30 patients in DC group had completed 103 chemotherapy cycles, the average was 3.4 cycles every patient; 29 patients in GC group had completed 104 chemotherapy cycles, the average was 3.6 cycles every patients. The response rates were 50% and 44.8% in DC group and GC group, 52.2% and 47.8% in initially treated DC group and GC group, 42.9% and 33.3% in re-treated DC group and GC group,respectively;the clinical benefit rates were 83.3% and 79.3% in DC group and GC group,respectively. DC group compared with GC group, there was no significant difference(P>0.05) in response rate and clinical benefit rate. Initial treatment group compared with re-treatment group ,there was no significant difference (P>0.05) for the response rate in DC group and GC group.2,The response rate of patients with squamous cell carcinoma, and adenocarcinoma were 50% and 46.7% in DC group, 50% and 46.2% in GC group .The response rates in the two group of the same pathological type were similar.3,The response rates of patients with ECOG 1 point and ECOG2 points were 66.7% and 20% in DC group, 55.6% and 12.5% in GC group respectively. The response rates of patients with ECOG 1 point had an obvious advantage over patients with ECOG 2 points,and there was significant difference(P<0.05); DC group compared with GC group ,there was no significant difference(P>0.05)in the response rate of patients with ECOG1 point and ECOG2 points, respectively.4,The response rates of patients withâ…¢b period andâ…£period were 58.8% and 30.8% in DC group, 53.3% and 35.7% in GC group .â…¢b period compared withâ…£period ,there was no significant difference(P>0.05)in the response rate in the two group.5,The median TTP was 4.9 months and 5.6 months,the median OS was 10 months and10.6 months, 1-year survival rate was 38.2% and 41.2 % in DC group and GC group, respectively. GC group compared with DC group ,there was no significant difference(P>0.05)in TTP, OS survival curve and 1-year survival rate.6,The most common adverse events seen in these trials were leukopenia, thrombocytopenia,decreased hemoglobin, nausea and vomiting, diarrhea, liver toxicity, tiredness, alopecia, severe muscle and joint pain, pulmonary toxicity, influenza-like syndrome. The incidence rates of leukopenia, muscle and joint pain ,alopecia in DC group were higher than those in GC group,and there were significant differences(P <0.05). The incidence rates of thrombocytopenia, pulmonary toxicity, and influenza-like syndrome were higher in GC group than those in DC group,and there were significant differences(P <0.05).Most adverse events happened in the two group were mild. Leukopenia, thrombocytopenia,decreased hemoglobin, nausea and vomiting, diarrhea, alopecia were serious, The incidence rates of serious leucopenia and alopecia in DC group were higher than those in GC group,and there were significant differences (P <0.05).Conclusion: Docetaxel and gemcitabine plus carboplatin respectively in the treatment for advanced non-small cell lung cancer have precise efficacy,there is no population with certain advantage in different pathology type and period, the adverse events are different, but tolerable.The two regimes both can be considered as the first and the second-line treatment for patients with good general states of advanced non-small cell lung cancer. Gemcitabine plus carboplatin has less,lighter toxicities. |
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