Clinical Study Of Bevacizumab Combined With Lobaplatin By Hyperthermic Intrathoracic Chemotherapy In The NSCLC With Malignant Pleural Effusion

Objective:The purpose of this study was to retrospectively analyze the short-term efficacy,quality of life and adverse reactions of Bevacizumab（trade name Avastin）combined with Lobaplatin in the treatment of advanced lung cancer with malignant pleural effusion（MPE）.Methods:Patients with advanced lung adenocarcinoma with large amount of malignant pleural effusion on one or both sides were collected from January 2021 to January 2022 at Hubei Provincial Third People’s Hospital.All patients were screened,KPS scores were more than 60 points,no lung cancer-driven gene mutation or driven gene mutation resistance,no chemotherapy-related contraindications.Before treatment,the pleural fluid was collected by thoracic puncture for biochemical and cytological tests.Cancer cells were found in the thoracic water with abnormal elevation of serum tumor markers.These samples were randomized into the control and the observation groups,each with 20 cases.The control group was treated with Lobaplatin,the dose was 50 mg/time,d1,d2w,twice a week,two sessions,followed by Docetaxel systemic intravenous chemotherapy at 75mg/m².The observation group was injected with Bevacizumab 5mg/kg,d1,d2w,intrapleural perfusion frequency and intravenous chemotherapy frequency on the basis of control group.Chest CT was used to compare the control of pleural fluid before and 1 month after treatment.To compare and analyze the changes of serum and tumor marker carbohydrate antigen（CA）125 and CEA before and 1month after treatment.The quality of life of the patients before and after treatment was evaluated by KPS score,and the adverse reactions during and after treatment were observed.The above data were statistically analyzed to evaluate the recent therapeutic efficacy,quality of life and clinical adverse reactions of the patients in the two groups.Results:The results showed that:7 cases of CR,8 cases of PRR,2 cases of SD and 3cases of PD in the observation group,3 cases of CR,6 cases of PR,6 cases of SD and 5 cases of PD in the control group,the ORR in the two groups was 75.0%（15/20）,45.0%（9/20）,and the DCR in the two groups was 85.0%（17/20）,75.0%（15/19）.The difference was statistically significant（P<0.05）.The short-term therapeutic effect of Bevacizumab combined with Lobaplatin was significantly better than that of Lobaplatin alone.Before and after treatment,CA125 and CEA in the serum and pleural fluid of the two groups were significantly decreased.Compared with the single perfusion group,the CEA in the Bevacizumab group was significantly decreased,which was（110.35±21.88）and(228.46±54.57μmol·L^-1,respectively.According to the KPS scores of the two groups before and after treatment,15cases were improved,4 cases were stable,1 case was decreased,13 cases were improved,5cases were stable,2 cases were decreased.Through clinical observation,the two groups of patients with chest tightness,asthma improved,the quality of life of the observation group than the control group improved more significantly.The analysis of adverse reactions showed that the incidence of adverse reactions was small and most of the cases were mild,and the incidence of grade III and IV adverse events was small.During the whole course of treatment,all the patients could tolerate the toxic effects of pharmacology and adverse reactions of perfusion without any withdrawal.Conclusion:In combination with Docetaxel systemic intravenous chemotherapy,Bevacizumab was more effective in the treatment of advanced lung adenocarcinoma with malignant pleural effusion compared to local pleural heat-perfusion chemotherapy with Lobaplatin alone.The decrease of serum and pleural tumor marker CEA was more significant,and the quality of life of the patients improved more significantly with fewer adverse reactions.However,a rigorous randomized controlled trial is required for the combination of Bevacizumab and Lobaplatin chemotherapy to be widely used in malignant pleural effusion.