Cisplatin/carboplatin-based third generation chemotherapy in the treatment of 299 patients with advanced squamous cell lung cancer:a clinical study

Objective:To compare the curative effects and adverse reactions between cisplatin-and carboplatin-based third generation chemotherapies in the treatment of patients with stage ⅢB/Ⅳ squamous cell lung cancer.Methods:To review 6 112 clinical records between June 2002 and May 2009 to identify 299 patients who had advanced squamous cell lung cancer and met the inclusion criteria.They were divided into two groups.Group A(n=225) received cisplatin-based third generation chemotherapy and group B(n=74) received carboplatin-based third generation chemotherapy.The chemotherapy was repeated every 21 d and the curative effects were evaluated after two cycles and were determined after 4 cycles.The primary end-point index was overall survival(OS) and the secondary end-point parameters were response rate(RR) and adverse reactions.Results:RR were 31.1%(70/225) and 28.4%(21/74) for group A and group B,respectively.The difference was not significant(P=0.658).The OS was more prolonged in group A than that in group B.The median survival time(MST) was 328 d for group A and 259 d for group B(P=0.012,HR=0.754,P=0.041).The 1-year survival rate in group A was higher than that in group B [48.9%(110/225) vs 31.1%(23/74),OR=2.121,P=0.008].Subgroup analysis demonstrated that for the patients at stage ⅢB the OS was more prolonged in the group A than that in group B.The MST were 347 and 302 d,respectively(P=0.027;HR=0.663,P=0.001).For the patients at stage Ⅳ the OS tended to be prolonged in group A compared with group B but the difference was not significant.The MST were 282 d and 253 d,respectively(P=0.152;HR=0.859,P=0.245).Multivariate analysis showed that clinical stage and gender were independent prognostic factors.Patients at stage ⅢB(HR=0.879,P=0.025) and female patients(HR=1.278,P=0.001) had better prognosis.Age was not related with the prognosis(HR=0.956,P=0.565).The incidence rate of grade Ⅲ to Ⅳ thrombocytopenia in group B was higher than that in group A(16.2% vs 7.1%,P=0.020),whereas the incidence rate of gastrointestinal reaction such as nausea and vomiting was significantly decreased in group B compared with group A(5.4% vs 16.9%,P=0.014).Conclusion:Cisplatin-based or carboplatin-based third generation chemotherapy had similar response rate in the treatment of advanced squamous lung cancer patients with higher PS score especially for those at ⅢB stage.But patients who received cisplatin-based third generation chemotherapy had higher overall survival rate.The gastrointestinal adverse reactions such as nausea and vomiting occurred more frequently.