Comparison Of Clinical Efficacy And Adverse Reactions Of Two Platinum Combined With Paclitaxel In Fallopian Tube Carcinoma And Epithelial Ovarian Cancer Chemotherapy

Objective: to compare the short-term and long-term efficacy and side effects of lobaplatin or carboplatin combined with paclitaxel in the initial chemotherapy for patients with fallopian tube carcinoma and epithelial ovarian carcinoma after operation,to further confirm the efficacy and safety of lobaplatin in postoperative chemotherapy of fallopian tube carcinoma and epithelial ovarian carcinoma.Methods: A total of 68 patients who were hospitalized in the first Hospital of Dalian Medical University and received postoperative chemotherapy with loplatin or carboplatin combined with paclitaxel from January 2015 to December 2021 were selected,there were26 patients in lobaplatin combined with paclitaxel group and 42 patients in carboplatin combined with paclitaxel group.After the first 3 courses of chemotherapy,the early clinical effect was evaluated according to the CA125 value and the change of residual tumor size in pelvic and abdominal cavity measured by whole abdominal CT scan.All patients were followed up,and recorded the date of death and the date of loss of followup.Progression free survival(PFS)was used to evaluate the long-term outcome,and univariate and multivariate analyses were used to explore the factors affecting PFS.The side effects were evaluated according to NCI-CTCAE 5.0 standard.Results: 1.ORR of lobaplatin combined with paclitaxel group and carboplatin combined with paclitaxel group were 71.4%(10/14)and 82.6%(19/23)respectively,DCR of this two groups were 85.7%(12/14)and 95.7%(22/23)respectively,and no statistically significant difference was observed in both groups(P>0.05).2.There was no significant difference in the initial CA125 level between the two groups(P=0.594).After the first course of treatment,the negative conversion rate of CA125 in lobaplatin group and carboplatin group was 35.7%(5/14)and 60.9%(14/23)respectively,and there was no significant difference between the two groups(P=0.184)After the third course of treatment,the negative conversion rates of CA125 in loplatin and carboplatin groups were 85.7%(12/14)and 91.3%(21/23)respectively,and no statistically significant difference was observed in both groups.(P=0.625).3.mPFS was 28.0 months(95% CI,4.5-51.5 months)in the lobaplatin combined with paclitaxel group,and could not be calculated in the carboplatin combined with paclitaxel group because more than half of the patients did not develop disease progression or die at the end of follow-up.There was no significant difference in PFS between the two groups(P=0.108).After excluding stage I patients mPFS was analysed again for both groups.mPFS was 18.0 months(95% CI,9.3-26.7 months)in the lobaplatin group;mPFS was 31 months(95% CI,10.3-51.7 months)in the carboplatin group,P=0.281 for comparison between the two groups.4.Based on the results of univariate and multivariate analysis,the independent prognostic factors for PFS in this study model were whether the patients achieved R1 by surgery or not(P=0.048).The risk of recurrence in patients who did not achieve R1 by surgery was2.332 times higher than that in patients who achieved R1.5.The incidence of leucopenia and granulocytopenia was not significantly different between the two groups.However,the incidence of grade 1-2 granulocytopenia was higher in lobaplatin than in carboplatin.(57.7% vs 20.6%,P=0.03),the incidence of grade 3-4 granulocytopenia was lower in the carboplatin group than in the carboplatin group(42.3% vs 76.5%,P=0.007).The overall incidence of thrombocytopenia was higher in the lobaplatin group than in the carboplatin group(42.3% vs 14.3%,P=0.010),and the incidence of grade 1-2 thrombocytopenia was higher in the lobaplatin group than in the carboplatin group(30.8% vs 9.5%,P=0.046),but there was no difference in the incidence of grade 3-4 thrombocytopenia between the two groups(11.5% vs 4.8%,P=0.363).The incidence of adverse reactions such as liver function impairment,nausea and vomiting were similar in both groups(P>0.05).Conclusion:1.Lobaplatin or carboplatin combined with paclitaxel for primary treatment of fallopian tube cancer and epithelial ovarian cancer after surgery showed good efficacy,the shortterm of the two were similar,and long-term efficacy was lower in lobaplatin group,but there was no statistical difference between the two groups;2.The most common side effect of loplatin and carboplatin was bone marrow depression,but carboplatin was more likely to develop grade 3-4 granulocytopenia than lobaplatin,and lobaplatin was more likely to develop thrombocytopenia than carboplatin,however,most thrombocytopenia were grade 1-2.