Clinical Study On Thalidomide Combined With Chemotherapy In The Treatmet Of Advanced Non-Small Cell Lung Cancer

Objectives:To investigate the effect of thalidomide combined with cisplatin-based chemotherapy and the value of serum levels of vascular endothelial growth factor(VEGF)in pacients with advanced non-small cell lung cancer(NSCLC).Methods:From March 2006 to July 2007,sixtysix patients having histological or cytological confirmed diagnosis of StageⅢB or StageⅣNSCLC were enrolled,all of whom received no prior chemotherapy or radiotherapy or surgery.Thirty-five of the patients received thalidomide combined with platin-based chemotherapy(trial group),the others received platin-based chemotherapy (control group).Patients must be receive 2-4 cycles of chemotherapy,and blood was collected before and after 2 cycles of chemotherapy.Serum VEGF levels were assessed by commercial ELISA。Results:1.All of the 66 patients were assessable response.There were no complete responses in both groups。The response rate were 45.7%(16/35)in trial group and 38.7%(12/31)in control group,response rate were not significantly different for both groups(P＞0.05).Higher clinical benefit rate(77.1% versus 58.1%;P=0.048)in trial group.Median time to progression (TTP)for the trial group was more longer than the control group,114 days(95%CI 86 to 141)versus 89 days(95%CI 59 to 118),P= 0.033.2.Fatigue,somnolence and neuropathy were more frequent in pacients of trial group,nobody was observed deep vein thrombosis or correlated death.3.The mean VEGF serum level in both groups decreased significantly after two courses of treatment(P=0.000).For both treatment groups combined,there was a 17%reduction in serum VEGF after two courses of treatment in patients with PR(P=0.000),a 8.2% reduction in patients with SD(P=0.000),but no significant reduction (1.5%;P=0.207)in patients with PD.The mean VEGF serum level of the patients treated with thalidomide was not significant lower than that without thalidomide(P=0.513).Conclusions:1.The treatment of thalidomide combined with platin-based chemotherapy improved the clinical benefit and TTP of the patients,but the response rate did not meet our predetermined level of efficacy to merit further investigation 2. Thalidomide at a dose≤400mg/day is relatively well tolerated.3.The results indicated that there may be relation between the serum VEGF level and the therapeutic effect.4.In the trial,additional thalidomide failed to significantly reduce the levels of VEGF。...