A survival study:three cisplatin combination chemotherapies in initial treatment of advanced non-small cell lung cancer

Background and purpose:Advanced non-small cell lung cancer(NSCLC) patients with poor prognosis,but the application of cisplatin-based two-drug combination chemotherapies can prolong survival time,but it is questionable how to choose chemotherapy.This study compared the response rates and survival time of 3 drugs(vinorelbine,paclitaxel,gemcitabine) combined with cisplatin in the initial treatment.Methods:A total number of 192 patients without chemotherapy for advanced NSCLC were randomly divided into NP(n=64),TP(n=63) and GP(n=65) group,and then a prospective open randomized controlled clinical research method was preformed.Chemotherapy-native patients were randomized to receive vinorelbine 25 mg/m2 on day 1 and 8 plus cisplatin 75 mg/m2 on day 2 every 28 days(NP arm),or paclitaxel 175 mg/m2(3-hour infusion) then cisplatin 75 mg/m2,both on day 1 every 21 days(TP arm),or gemcitabine 1 250 mg/m2 on day 1 and 8 plus cisplatin 75 mg/m2 on day 1 every 21 days(GP arm).After a period of at least 2 cycles of chemotherapy,the response rate and survival time and adverse reaction were evaluated and compared.Results:There was no significant difference in the effective rate among the 3 groups(NP group 29.69%,TP group 33.33%,GP group 32.30%).In the GP,TP and NP groups,the median survival time was 9.8,9.9 and 9.5 months,and the year survival rates were 40%,38% and 37%,respectively.No significant differences were found in the overall survival,disease progression and treatment failure time among the 3 groups.Neutropenia was significantly higher on the NP arm(NP group of 45% per cycle,TP group 32%,GP group 18%,P0.001),as was thrombocytopenia on the GP arm(16%) than the other 2 groups(NP group 1%,TP group 2%,P0.001).Alopecia and peripheral neurotoxicity were most common on the TP arm,as was nausea/vomiting on the NP arm(P0.05).Conclusion:Efficacy end points were not significantly different in 3 arms,although toxicities showed differences.Three cisplatin combination chemotherapies in the treatment of advanced NSCLC have been in a plateau,and chemotherapy should be individualized.