| Background and objective:Lung cancer is the world’s highest incidence of malignant tumors, but also the leading cause of cancer-related deaths, and the incidence rate increased year by year, age of onset smaller. According to histological classification, mainly in small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) two categories, and non-small cell lung cancer accounts for which more than85%, non-small cell lung cancer is further divided into squamous cell carcinoma, adenocarcinoma, large cell carcinoma are three main subtypes. And among the primary lung cancer, pulmonary adenocarcinoma accounts for about40%occur in women with non-smoker, early pulmonary adenocarcinoma is typically only as cough, fever, blood in sputum, chest pain, chest tightness and other common respiratory disease. There symptoms are most often considered a common respiratory disease is not very concerned about, so until the discovery of lung cancer has been the most late metastasis and has lost the chance of operation. With the rapid development of science and technology, diagnostic and treatment of lung cancer is increasing, more and more advanced. In recent years, new tools for advanced pulmonary adenocarcinoma, as targeted therapy, biological therapy, has achieved remarkable results. However, traditional chemotherapy for the advanced pulmonary adenocarcinoma is the primary choice in clinical now, especially EGFR wild-type pulmonary adenocarcinoma.The commonly used chemotherapy drugs are pemetrexed, docetaxel, paclitaxel, vinorelbine, platinum etc. Although already well extended the survival time of patients, but even so, recurrence and cancer-related deaths are still common, adverse reactions are large, poor tolerance.The key of tumor’s growth and metastasis is new angiogenesis. When the tumor volume is increasing, and the tumor tissue hypoxia occurs, thereby stimulating blood vessels factor releasing, activation like waterfall, thus speeding up the generation of new blood vessels. One of the most important pro-angiogenic factors is vascular endothelial cell growth factor (VEGF), VEGF and its receptor (VEGFR-1, Flt-1, VEGFR-2, Flk-1/KDR) binding, activation of the receptor tyrosine kinase and induce new blood vessel formation. More and more studies have shown that over-expression of VEGF and its receptors are present in the tumor, by making it possible to block VEGF binding to its receptors to inhibit tumor angiogenesis becomes an anti-tumor therapy.Bevacizumab (BEV) is a VEGF-specific antibody that is capable of specifically blocking or weakening its binding VEGF to inhibit the proliferation of vascular endothelial cells, reducing tumor angiogenesis, hindering tumor growth and metastasis, to achieve the anti-tumor effect. In recent years, an increasing number of clinical trials have demonstrated that bevacizumab for advanced colorectal cancer, non-small cell lung cancer, breast cancer, kidney cancer and other solid tumors have the exact effect. In view of this, in2006, the American Food and Drug Administration (FDA) approved bevacizumab join PC program for the treatment of advanced non-squamous NSCLC.This study collected68cases advanced pulmonary adenocarcinoma, treating by bevacizumab plus pemetrexed and platinum programs or pemetrexed plus platinum, to retrospectively analyze. To evaluate the efficacy and safety of bevacizumab in combination with pemetrexed plus platinum in first-line treatment of advanced pulmonary adenocarcinoma, further confirm the clinical value of bevacizumab, better guide their application in clinical. Materials and methods:A retrospective analysis of our hospital68cases of advanced pulmonary adenocarcinoma patients, which met the study criteria. The33patients of BEV group (study group) which used bevacizumab in combination with pemetrexed plus platinum(cisplatin/carboplatin/nedaplatin).The35patients of single-chemotherapy group(control group) which used only pemetrexed plus platinum.21days for a cycle and every2cycles evaluated.Result:Because of chemotherapy and tumor progression, three cases of BEV group and four cases of single-chemotherapy group stop treatment in3-6cycles. Surplus completed six cycles of therapy,68cases can be evaluated. The single objective response rate (ORR) of BEV group and single-chemotherapy group were57.6%and28.6%, with BEV group objective response rate compared with single-chemotherapy group had significantly improved, the difference between the two was statistically significant (x2=5.842, P<0.05), disease control rate (DCR) was84.8%and68.6%. The disease control rate of BEV group high than single-chemotherapy group, but the difference was not statistically significant (P>0.05). The median time to progression and median survival time of BEV group were8.2m and14.6m. The single-chemotherapy group were6.1m and11.4m. To analy the PFS curves and survival curves by Kaplan-Meier analysis (Log-rank test),χ2were7.064and10.739, P<0.05, the difference was statistically significant.Conclusion:The clinical benefit of bevacizumab in combination with pemetrexed plus platinum was higher than just pemetrexed plus platinum in advanced pulmonary adenocarcinoma. The short and long term effects are obviously improved. The incidence of adverse reactions of BEV group was relatively higher than single-chemotherapy group, but in addition to hypertensionthe, the rest were not statistically significant, mostly mild and can be controlled. This need to further expand the sample size for analysis. |
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