Efficacy and prognostic factors of 178 advanced non-small lung cancer patients undergoing different second-line chemotherapeutic regimens
10.3760/cma.j.issn.0253-3766.2016.04.010
- VernacularTitle:不同二线方案治疗178例晚期非小细胞肺癌的预后及影响因素
- Author:
Qian KONG
1
;
Xinyue WANG
;
Richeng JIANG
;
Yi BA
;
Kai LI
Author Information
1. 300060,天津医科大学肿瘤医院肺部肿瘤内科 天津市肿瘤防治重点实验室 国家临床医学研究中心
- Keywords:
Carcinoma,non-small-cell lung;
Antineoplastic combined chemotherapy protocols;
Prognosis
- From:
Chinese Journal of Oncology
2016;38(4):294-299
- CountryChina
- Language:Chinese
-
Abstract:
Objective The purpose of this study is to explore the efficacy and predictors of second?line chemotherpy in advanced non?small cell lung cancer patients and suggest optimal protocols suitable for differently characterized patients. Methods The clinical data of 178 advanced NSCLC patients second?line?treated in Tianjin Cancer Hospital from 2009.1.1 to 2013.12.31 were retrospectively analyzed. According to the different second?line treatments, the patients were divided into standard mono?drug therapy group ( 46 cases), endostar combined with standard mono?drug therapy group (42 cases), and platinum?based doublet chemotherapy group ( 90 cases) . Kaplan?Meier and Log?rank analyses were used to estimate and compare the survival rates in the groups, and Cox′s hazard regression model was used to determine the prognostic factors. Chi?square test was used to analyze the differences among different groups. Results The median progression?free survivals ( mPFS) were 50 days, 54 days, and 79 days ( P=0.042) for the standard mono?drug therapy group, endostar combined with standard mono?drug therapy group, and platinum?based doublet chemotherapy group, respectively. The differences between the mono?drug therapy group and doublet chemotherapy group were statistically significant ( P=0. 011 ) . The disease control rate ( DCR ) for each group was 26.1%, 47.6% and 46.7% (P=0.041), and the DCR were statistically significantly different between the mono?drug therapy group and doublet chemotherapy group ( P=0.016) , and between the mono?drug therapy group and endostar combined with standard mono?drug therapy group (P=0.041). The overall response rate (ORR) for each group was 2.2%, 0, and 4.4% (P>0.05 for all). Multivariate analysis showed that the period from the begining of first?line to second?line chemotherapy ( progression?free time) , base?line clinical stage, neuron specific enolase ( NSE) before second?line therapy, the cycles of second?line chemotherapy and the response to second?line therapy were independent predictors for PFS ( P<0. 005 for all) . Subgroup analysis indicated that the patients obtained more clinical benefit from doublet chemotherapy rather than mono?drug therapy, with following factors: age<60 years, paclitaxel plus cisplatin for first?line treatment, chemotherapy cycles≤4, CR, PR and SD for response, progression time within 3?6 months from the begining of first?line to second?line chemotherapy, performance status score≤1 at the begining of second?line therapy,Ⅳ stage, and mild leukopenia ( P<0.05 for all) . The patients whose progression?free survival time within 3?6 months from the begining of the first?line to second?line chemotherapy got more clinical benefit from endostar combined with standard mono?drug chemotherapy than mono?drug therapy ( P=0.006) . Conclusions The period from the begining of first?line to second?line chemotherapy, base?line TNM stage, NSE before second?line chemotherapy, the cycles of second?line chemotherapy and the response to second?line therapy were independent predictors for PFS. Platinum?based doublet chemotherapy and endostar plus standard second?line regimen can improve the efficacy in some characterized advanced NSCLC as compared with the patients by standard mono?drug therapy, wherein the platinum?based chemotherapy revealed the best efficacy.
