Efficacy of different first-line chemotherapy regimens for advanced lung adenosquamous carcinoma
Objective To compare the therapeutic efficacy of pemetrexed versus paclitaxel/gemcitabine-based first-line chemotherapy regimen on advanced lung adenosquamous carcinoma,and to explore their influences on the survival of patients.Methods From January 2012 to April 2022,71 patients with advanced lung adenosquamous carcinoma were diagnosed and treated in Fujian Cancer Hospital,Zhangzhou Zhengxing Hospital,the Affiliated Hospital of Putian University,the Affiliated Zhangzhou Hospital of Fujian Medical University,the First Affiliated Hospital of Xiamen University,the Affiliated Zhongshan Hospital of Xiamen University,Fuding City Hospital and the First Hospital of Quanzhou,among whom 16 patients received pemetrexed chemotherapy regimen(pemetrexed group)and 55 patients received paclitaxel/gemcitabine chemotherapy regimen(paclitaxel/gemcitabine group).During chemotherapy,epidermal growth factor receptor tyrosine kinase inhibitor,antiangiogenic drugs,or immune checkpoint inhibitors were applied in combination according to gene detection results and other factors,and the efficacy was evaluated once every 1 to 2 cycles of chemotherapy.The gender ratio,age,smoking habits,Eastern Cooperative Oncology Group(ECOG)score,brain metastasis,liver metastasis,bone metastasis,gene mutation,and expression of programmed death ligand 1(PD-L1)were compared between two groups.The short-term efficacy of first-line chemotherapy was compared between two groups.The latest follow-up was conducted in October 2022,and the median progression-free survival(mPFS)was compared between two groups,and also in patients with different gender,age,ECOG score,and with and without brain metastasis,liver metastasis,bone metastasis and gene mutations.Results(1)The female ratio was higher in pemetrexed group(56.2％)than that in paclitaxel/gemcitabine group(23.6％)(x2=6.165,P=0.017).There were no significant differences in the proportions of patients with age ≥65 years,ECOG score ≥2,smoking habits,brain metastasis,liver metastasis,and bone metastasis between two groups(P＞0.05).(2)In pemetrexed group,7 patients received gene detection,and EGFR mutation was detected in all patients.In paclitaxel/gemcitabine group,33 patients received gene detection,revealing EGFR mutation in 6 patients,EGFR mutation combined with c-MET amplification in 1,ALK mutation in 1,HER2 mutation in 1,KRAS mutation in 1,TP53 mutation in 1,and TP53 mutation combined with BRAF mutation in 1.In pemetrexed group,PD-L1 expression was negative in 1 patient.PD-L1 was expressed in 7 patients(including 3 patients with positive expression and 4 with negative expression)in paclitaxel/gemcitabine group.(3)There were no significant differences in the objective response rate and disease control rate between pemetrexed group(43.8％,75.0％)and paclitaxel/gemcitabine group(41.8％,76.4％)(x2=0.019,P=0.5556;x2=0.013,P=0.574).(4)In the follow-up till October 2022,6 were lost and 65 survived.There was no significant difference in the mPFS between pemetrexed group[4.1 months(95％CI:0-10.25)]and paclitaxel/gemcitabine group[6.4 months(95％CI:4.27-8.53)](P=0.116).(5)The mPFS was longer in advanced cancer patients with ECOG score 0-1[6.4 months(95％CI:5.19-7.61)]than that in patients with ECOG score ≥2[2.0 months(95％CI:0-4.87)](P=0.020),and in patients without liver metastasis[6.7 months(95％CI:5.11-8.35)]than that in patients with liver metastasis[2.0 months(95％CI:0.31-3.63)](P=0.003).There was no significant difference in the mPFS in patients with different gender,age,and with and without brain metastasis,bone metastasis and gene mutations(P＞0.05).Conclusion In patients with advanced lung adenosquamous carcinoma,the short-term efficacy of first-line chemotherapy with pemetrexed or paclitaxel/gemcitabine-based regimen and the mPFS are comparable,and the mPFS would be shortened in patients with ECOG score ≥2 and liver metastasis.
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万方数据
维普
