Efficacy Of Recombinant Adenovirus Type 5 Combined With Recombinant Human Endostatin In The Treatment Of NSCLC With Malignant Pleural Effusion

Background and objectiveIn lung cancer patients,15% of patients with Malignant pleural effusion(MPE),leading to chest tightness,shortness of breath and other symptoms,seriously affect the quality of life,if the MPE can not be treated in time,the prognosis is poor,the survival period is generally lower than 6 Months.Thoracentesis of anti-tumor drugs can reduce the production of pleural fluid.Recombinant human endostatin can effectively control pleural effusion by inhibiting proliferation,migration and differentiation of vascular endothelial cells and reducing tumor vascular permeability.Recombinant human type 5 adenovirus lyses tumor cells by specific infection of tumor cells by oncolytic adenovirus,and can also reduce the production of pleural effusion.This study was divided into retrospective studies and randomized clinical trials.A retrospective study focused on the short-term efficacy of recombinant human endostatin versus cisplatin in the treatment of non-small cell lung cancer(NSCLC)with MPE.Randomized clinical trials were divided into two groups according to random number method.The efficacy and safety of recombinant human adenovirus type 5 combined with recombinant human endostatin in thoracic perfusion or cisplatin thoracic perfusion in the treatment of NSCLC with MPE were investigated.Methods1.Retrospective study: The clinical data of 69 patients with NSCLC complicated with MPE from 2016 to 2018 in the Xinqiao Hospital of Army Military Medical University were collected.According to different treatment methods,23 patients were enrolled in the Endo group and 46 patients in the cisplatin group.The pleural effusion was exhausted before treatment in both groups.The encephalopathy of the Endo group was 30 mg twice a week,and the cisplatin group was intraperfused with cisplatin 30 mg/m 2 twice a week to investigate the short-term efficacy and adverse reactions of the two drugs.Difference2.Randomized clinical trial: 50 patients with advanced NSCLC complicated with malignant pleural effusion were randomly divided into control group(26 cases)and combination group(24 cases).Before the treatment,the pleural effusion was drained.On the basis of systemic chemotherapy with platinum-based regimen,the control group received 30 mg/m2 of cisplatin in the chemotherapy regimen;the combined group received cerebral infusion(recombinant human endostatin injection)30 mg and Ankerui(recombinant human type 5 adenovirus)0.5ml × 3,2 times / week.Compare the effectiveness and safety of the two groups.The main indicators were pleural effusion relief,progression-free survival,and adverse events.Results1.In the retrospective study,the objective response rate(ORR)of the Endo group was 56.5%,and the ORR of the cisplatin group was 26.1%.The treatment effect of the Endo group was significantly better than that of the cisplatin group,and the difference was statistically significant(P<0.05).The stratified analysis found that in patients with bloody pleural effusion,the ORR group had an ORR of 88.9% and the cisplatin group had an ORR of 5%,and the difference was statistically significant(P<0.05).In patients with non-blood pleural effusion,the ORR group had an ORR of 35.7% and the cisplatin group had an ORR of 42.3%.Among the patients with lower carcinoembryonic antigen(CEA)values(<100?g/L)in the pleural effusion,the ORR group had an ORR of 53.8% and the cisplatin group had an ORR of 8.3%.The difference was statistically significant(P<0.05)..Among patients with higher CEA values(?100 ?g/L)in the pleural effusion,the ORR group had an ORR of 50% and the cisplatin group had an ORR of 45.4%.2.In the randomized clinical trial,the objective effective rates of pleural effusion in the combined group and the control group were 62.5% and 26.9%,respectively,and the difference was statistically significant.The median progression-free survival was 6.4 and 3.3 months,respectively.Learning meaning.The T lymphocyte subsets in the peripheral blood of the combined group were higher than the control group,and the difference was statistically significant.There was no significant difference in the incidence of grade III and IV toxicity between the two groups.Conclusions1.Endovascular perfusion for the treatment of NSCLC combined with MPE is a safe and effective treatment,short-term efficacy is better than cisplatin,especially for patients with bloody pleural effusion,pleural effusion CEA value is lower(<100ug / L)The effect of the patient is more obvious.And the Endo group had less adverse reactions than the cisplatin group,and the safety was good,which can significantly improve the patient's physical state.2.On the basis of platinum-containing systemic chemotherapy,the clinical efficacy of recombinant human adenovirus type 5 combined with recombinant human endostatin in the treatment of NSCLC with malignant pleural effusion is better than that of cisplatin intraluminal perfusion,PFS is longer,can Promotes infiltration of T lymphocytes without significantly increasing adverse drug reactions.