| Background and objective：In recent years, the morbidity andmortality of lung cancer showed a trend of rising year by year, which hasbecome one of the world’s highest morbidity and mortality of malignanttumor. The morbidity and mortality of non-small cell lung cancer(NSCLC) accounts for80%~85%of total lung cancers, mainlyincluding squamous carcinoma, adenocarcinoma and large cellcarcinoma, and the proportion of lung adenocarcinoma are higher thanthat of NSCLC of other types. The division of non-small cell cancercells is more slowly, and their diffusion and metastasis are later thanthose of small cell lung cancer. At present, according to the clinicalanalysis of NSCLC, the patients are treated with individualizedcomprehensive therapy, and surgical resection is mainly suitable for I, II,stage and IIIA patients. At the time that they have been diagnosised morethan70%of the patients with NSCLC are already in locally advancedphase III or distant metastasis (phase IV), and the majority of them havelost the surgery opportunity, so the chemotherapy of these patientsoccupy the important position in these part of patients. These patients’ prognosis is poorer,1year survival rate of them is about10%, and themain treatment goal utmost is extending patient survival duration andimproving their life quality. For the late patients, their viscera functionoften is decline, and their resistance to chemotherapy also is poor, solimiting the use of the chemotherapy drugs. Now the platinum-based twodrugs are used as the first-line chemotherapy of lung cancer. Pemetrexed(pemetrexed) is a new kind of antitumor drug, which plays a role in avariety of enzyme of the folic acid dependent metabolic pathways, is aantifolic acid drug in many targets, and has less adverse reactions andgood application prospect. Pemetrexed has been approved by food anddrug administration (FDA) for the treatment of malignant pleuralmesothelioma and NSCLC. Gemcitabine is a kind of anti-metabolicdrugs, which has higher antitumor activity. The American FDA haveapproved Gemcitabine to use as the first-line chemotherapy drug forNSCLC in1996. Studies have shown that nedaplatinum is cisplatinanalogues, its renal toxicity and neurotoxicity were much lower than thatof cisplatin, and has no cross resistance completely with other platinumdrugs. In this paper, we choose96patients with advanced adenoma lungcancer in hospital, which treated using the pemetrexed combined withnedaplatinum and the gemcitabine combined with nedaplatinum schemeto study the recent clinical efficacy and safety through the contrastanalysis so as to provide ideas for clinical work. Methods: We elected96advanced adenoma lung cancer patientswho were correspond with the condition, which were divided into thepemetrexed combined with nedaplatin chemotherapy and gemcitabinecombined with nedaplatin chemotherapy groups. The patients useddexamethasone before given pemetrexed to reduce the happening of the rash,which supply the folic acid and vitamin B12during the process of usingpemetrexed. The doses of Pemetrexed combined with nedaplatin: Pemetrexed500mg/m2,1std; nedaplatin80mg/m2,2ndd and3rdd. The doses ofGemcitabine combined with nedaplatin: Gemcitabine1000mg/m2,1std and8thd; nedaplatin80mg/m2,2ndand3rdd. One cycle program ofadministration in each group was21days, which evaluated after eachtwo cycles. Each patient should complete at least two cycles ofchemotherapy. According to RECIST standard the curative effect wasevaluated after the patients with tumor were treated by the combinedtherapy. The patients were given with symptomatic treatment, includingthe anti-nausea, protecting liver, gastric mucoma and so on intreatment process, recording the bone marrow suppression and thegastrointestinal reaction degree, and timely giving recombinant humangranulocyte stimulating factor and recombinant human interleukin-11toincrease the blood cells. The adverse reaction in the two groups wasassessed according the above standard.Results: Eventually96patients in all completed383cycles ofchemotherapy, and, each patient completed the four cycles ofchemotherapy on average. There were42cases in the patients ofPemetrexed combined with nedaplatinum group; the effective rate was31.0%, and the disease control rate was69.0%. There were54cases inthe patients of gemcitabine combined nedaplatin group; the effective ratewas26.0%, and the disease control rate was68.5%. There not was the difference between the two groups (P>0.05). With further study, afterthe initial/retreatment, male/female, and PS score0-1/PS score2stratified analysis, the efficient rates of patients treated with thecombined therapy in two groups also were higher, but there not was thedifference between the two groups (P>0.05). The main adversereactions of patients in the two group were nausea, vomiting,gastrointestinal reaction and marrow inhibition, and the incidence rate ofleucopenia, thrombocytopenia and nausea in the III–IV stage patientsof pemetrexed group decreased statistically (P <0.05). The tumormarkers in the patients of both groups decreased statistically aftertreatment, but there was no statistical significance between those in thetwo groups.Conclusions: The treatment efficacy in the pemetrexed combinedwith nedaplatin and gemcitabine combined with nedaplatinum groupsfor advanced lung adenocarcinoma all were good, which had higheffective rate and disease control rate, and there was no statisticallysignificant difference between two groups. After initial/retreatment,male/female, PS score0-1/PS score2stratified analysis, There also wasa high effective rate in the patients of each group, also no statisticaldifference. The bone marrow suppression and gastrointestinal reaction inchemotherapy of the pemetrexed group were lighter than those in thegemcitabine group, and there were statistically significant differences inthe white blood cells, platelets, nausea and vomiting degree between thetwo groups. After the patients were treated in the two groups the tumormarkers reduced in a certain extent, but no statistically significantdifference. On basis of the above–mentioned results, pemetrexedcombined with nedaplatin is more suitable for the treatment of advancedlung adenocarcinoma rather than the gemcitabine combined with nedaplatin. |
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