异环磷酰胺联合奈达铂与单药多西他赛二线治疗晚期肺鳞癌的临床比较

摘要

Objective To contrast ifosfamide plus nedaplatin and single agent docetaxel in the therapeutic efficacy, toxic reactions and prognostic factors as second-line treatment for advanced lung squamous cell carcinoma patients.Methods The clinical data of 77 patients with advanced lung squamous cell carcinoma received second-line chemotherapy in Hunan cancer hospital were analyzed retrospectively.Among them, 37 patients received ifosfamide plus nedaplatin (combination agent) and others received doeetaxel only(single agent).Therapies were take as follow: IFO 1.3g/m2 d1-d3 ,NDP 80-100mg/m2 d1, TXT 75mg/m2 d1.Every 21 day was a cycle and efficacy and toxicity were evaluated after 2 cycles.Results The objective response rate (RR) of combination agent was 40.5％, which was higher than that of single agent (P ＜0.05).The disease control rate (DCR) of combination agent was 86.5％ and DCR of single agent was 75.0％.Median overall survival time (mOS) of combination agent was 10 months,and mOS of single agent was 9 months.There were no statistical differences between two groups.Median progression free survival time (1nPFS) of combination agent was 18 weeks, and mPFS of single agent was 13 weeks.There were statistical differences between two groups.In the aspect of toxic reactions, leucocyte and platelet in combination agent were more sharply decrease than that of single agent, and nausea and vomiring in the former were more frequent than that of the later.PS grade before the treatment, the stage of tumor and the benefit of secondline chemotherapy were independent prognostic factors for patients.Conclusion In the second-line treatment for advanced lung squamous cell carcinoma, compared to the single agent, the combination agent could obviously increase the response rate and prolong the progressive free survival time of patients without the overall survival time.The combination agent was more toxicity to patients' blood and digestive tract, but it could tolerate.%目的 比较国产异环磷酰胺(IFO)联合奈达铂(NDP)与单药多西他赛(TXT)二线治疗晚期肺鳞癌的疗效、毒副反应及预后.方法 回顾性分析我院接受二线化疗的77例晚期肺鳞癌患者的临床资料,37例接受IFO联合NDP治疗(联合组),40例接受单药TXT治疗(单药组).具体用药如下:IFO 1.3g/m2,d1～d3;NDP 80～100mg/m2,d1;TXT 75mg/m2,d1.均21天为1周期,2周期评价疗效和毒副反应.结果 联合组客观有效率(RR)为40.5%,单药组RR为17.5%,两组差异具有统计学意义(P＜0.05);联合组疾病控制率(DCR)为86.5%,单药组DCR为75.0%.联合组1年生存率为32.1%,中位总生存期(OS)为10.0个月,单药组1年生存率为29.2%,中位OS为9.0个月,两组差异无统计学意义(P＞0.05);联合组中位无进展生存期(PFS)为18.0周,单药组中位PFS为13.0周,两组差异有统计学意义(P＜0.05).联合组的毒副反应包括白细胞减少、血小板减少及恶心、呕吐,发生率均明显高于单药组.经Cox多元回归分析,治疗前PS评分、肿瘤分期及二线治疗获益情况均为影响患者生存的独立预后因素.结论 IFO联合NDP方案较单药TXT二线治疗晚期肺鳞癌患者未显著增加患者的OS,但近期有效率更高,并能延长患者的PFS;血液学及消化道毒副反应更明显,但可耐受.