Clinical Observation Of Pemetrexed Plus Cisplatin And Docetaxel Plus Cisplatin In Chemotherapy-naive Patients With Advanced Lung Adenocarcinoma

Objective:To compare the clinical efficacy and safety of pemetrexed plus cisplatin anddocetaxel plus cisplatin in the chemotherapy-naive patients with advanced lungadenocarcinoma.Methods:We elected69advanced lung adenocarcinoma patients who corresponded with theconditions in our hospital. The patients were separated into pemetrexed/cisplatin group of36cases and docetaxel/cisplatin group of33cases. Pemetrexed/cisplatin group:Pemetrexed500mg/m2d1, cisplatin25mg/m2d1-3, pretreated drugs includeddexamethasone, folic acid and vitaminB12. Docetaxel/cisplatin group: Docetaxel75mg/m2d1, cisplatin25mg/m2, d1-3, pretreated drugs included dexamethasone. At the same timetwo groups give the symptomatic treatment of protection of gastric mucosa, liverprotection and antiemetic.21days for one cycle in the two groups. Each patient completedat least two cycles of chemotherapy, evaluated after each two cycles. Given recombinanthuman granulocyte colony stimulating factor and recombinant human interleukin-11according to the myelosuppression.Results:The objective response rate (ORR) was41.7%in pemetrexed/cisplatin group and39.4%in docetaxel/cisplatin group, without significant difference (P=0.848). The diseasecontrol rate (DCR) was77.8%in pemetrexed/cisplatin group and72.7%indocetaxel/cisplatin group, without significant difference (P=0.627). Subgroup analysisshowed that gender, age, smoking or not didn’t make any differences to the ORR in thetwo groups. The median PFS was5.7months in pemetrexed/cisplatin group, better than indocetaxel/cisplatin group (4.5months), but the difference between the two groups was no statistical significance (P=0.301). The1year survival rate was58.3%(21/36) inpemetrexed/cisplatin group and54.5%(18/33) in docetaxel/cisplatin group, withoutstatistical significance (P=0.751). In pemetrexed/cisplatin group，the adverse events mainlyincluded white blood cell reduction (38.9%), neutrophil reduction (30.6%), anemia(25.0%), platelet reduction (19.4%), ausea/vomiting (72.2%), constipation (19.4%), ALTincrease (13.9%), AST increase (13.9%), alopecia (27.8%), fatigue (38.9%), etc. Most ofthe adverse events were mild and could be tolerated. In docetaxel/cisplatin group，theadverse events mainly included white blood cell reduction (63.6%), neutrophil reduction(57.6%), anemia (36.4%), platelet reduction (42.4%), ausea/vomiting (72.7%), constipation(15.2%), ALT increase (12.1%), AST increase (15.2%), alopecia (51.5%), fatigue (45.5%),etc. The incidence of white blood cell reduction, neutrophil reduction, platelet reduction,alopecia and Ⅲ~Ⅳ degree of adverse events in pemetrexed/cisplatin group was lower thanin docetaxel/cisplatin group, with statistical significance (P<0.05). The quality of life: Inpemetrexed/cisplatin group, the improvement of quality of life was19cases (52.8%), thestability was9cases (25.0%) and the lower was8cases (22.2%), while the quality of lifein docetaxel/cisplatin group were9cases (27.3%),10cases (30.3%) and14cases (42.4%),respectively. In pemetrexed/cisplatin group, the rate of improvement in quality of life washiger than in docetaxel/cisplatin group, with statistical significance (P=0.031).Conclusion:The clinical efficacy of pemetrexed and docetaxel plus cisplatin for the treatment ofchemotherapy-naive patients with advanced lung adenocarcinoma was roughly the same,but the adverse events decreased significantly in the pemetrexed/cisplatin group comparedwith those in the docetaxel/cisplatin group. Therefore, pemetrexed plus cisplatin can beone of the preferred first-line treatments of patients with advanced lung adenocarcinoma.