| Objective:To review the therapeutic effect and safety of patients with primary small cell lung cancer(SCLC)treated by the Lobaplatin Combined with Etopside(EL)regimen in the Department of oncology of Tianjin Medical University General Hospital from May,2015 to December,2017,in order to obtain more clinical experience..Method:We reviewed and followed up the information by consulting medical records and telephone inquring,and the like,to collect the data untilthe last follow-up date of March 31,2018.The data was analyzed by SPSS 21.0 and Graphpad 5.0.The Kaplan-Meier Method was used for survival analyses and the log-rank test was used for single factor analysis.Cox multivariate regression analysis was carried out by using cox proportional hazards model to calculate the hazard ratios(HR)and corresponding 95%confidence intervals(CI).The rate was compared byc~2 tests.P values were considered significant if less than 0.05.The primary end points in this study were progression free survival(PFS)and overall response rate(ORR),and the secondary end point was overall survival(OS).Results:1.Patient characteristics:the average age of patients was 63 years(range:47-81years),the onset age was mostly over 60 years(74.4%);male predominated(69.2%);the majority(86.0%)of the patients had a positive history of smoking;39cases(90.7%)with Karnofsky score≥80;the number of patients diagnosed with ED-SCLC(31 cases)was obviously more than that of LD-SCLC(12 cases);bronchoscopy(58.1%)was the main diagnostic method.2.Among the 36 assessable patients from the whole group,no patient(0.0%)achieved CR,23 patients(63.9%)had PR and 11(30.6%)patients had SD,for an ORR of63.9%and a DCR of 69%.The median PFS and OS in all patients were 4.87months(95%CI:3.57-10.23 months)and 11.37(95%CI:8.24-14.50)months,respectively.Among the 12 patients who had limited disease,the ORR and DCR were 90.9%and100.0%,respectively;the median PFS was 6.90 months(95%CI:3.57-10.23 months),whereas the median OS was not achieved.Among the 31 patients who had extensive disease,an ORR of 52.0%and a DCR of 92.0%were achieved;the median PFS and OS were 4.70 months(95%CI:2.27-7.13 months)and 10.87(95%CI:6.68-15.06)months,respectively.3.All the patients(43 cases)were used for toxicity evaluation.The major adverse effects were hematological toxicities,gastroenterological toxicities,fatigue and alopecia.Among the hematological toxicities,gradeⅢ/Ⅳleukopenia occurred in 15patients(34.9%),gradeⅢ/Ⅳneutropenia occurred in 30 patients(69.8%),gradeⅢ/Ⅳanemia occurred in 7 patients(16.3%),and gradeⅢ/Ⅳthrombocytopenia occurred in 4 patients(9.3%).For gastroenterological toxicities,no patient experienced gradeⅣtoxicity.The gradeⅢgastroenterological toxicities only included nausea(4.7%).The average time for the most severe neutropenia occured was 2.36 cycles after chemotherapy,while the cumulative dose of Loplatin was 70.73mg/m~2.The incidence of fatigue was 62.8%,of which 2(4.7%)patients had gradeⅢand no patient experienced gradeⅣ.The incidence of alopecia was 46.5%,of which1(2.3%)patients had gradeⅢand no patient experienced gradeⅣ.According to thec~2 test,there was no statistical difference in the incidence of gradeⅢ/Ⅳneutropenia irrespective of age,sex,Karnofsky score,stage and comorbidities at first diagnosis.Conclusion:1.Small cell lung cancer(SCLC)usually occurs in the male over 60 years old,and predominates in the extensive stage.Most patients were diagnosed by bronchoscopy.2.The response of Lobplatin combined with Etoposide regimen on the treatment of chemocherapy-naive small-cell lung cancer was basically consistent with the literatures.3.The factors affecting PFS in patients with small cell lung cancer include VALSG staging,whether or not the patients had distant metastasis upon first diagnosis,and received thoracic radio therapy before progression in the first-line chemotherapy.Among all these factors,whether or not the patients received thoracic radio therapy before progression in the first-line chemotherapy an independent factor affecting PFS.4.The factors affecting OS in patients with small cell lung cancer include age,VALSG staging,whether or not the patients had distant metastasis upon first diagnosis,and received thoracic radio therapy,4 full cycles of the first-line chemotherapy,or second-line chemotherapy.Among all these factors,age is an independent factor affecting OS.5.The regimen of Loplatin combined with Etoposide in patients with chemotherapy-naive SCLC showed main adverse effects of myelosuppression,especially neutropenia,and mild side effects of nonhematological toxicities,suggesting good safety tolerance.6.The incidence of gradeⅢ/Ⅳneutropenia was high but controllable.There was no statistical difference in the incidence of patients with different age,sex,Karnofsky score,stage,and initial diagnosis with or without comorbidities.7.A further study on how to prevent and treat neutropenia more effectively is required. |
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