The Results of Locally Advanced and Metastatic Non Small Cell Lung Cancer Therapies and The Comparison of The Different Chemotherapy Protocols

Abstract

Non small cell lung cancer is the cause of 70-80% of all lung cancers, also it has the biggest cancer mortality ratio among all other cancer cells. Approximately 50% of patients during diagnosis are at advanced level of cancer. Because advanced stages of lung cancer is a systemic disease, the primary treatment for this is systemic chemotherapy. Nearly 5% of patients can survive one year without treatment. Because full recovery is not possible for the patients with metastatic lung cancer, the objective of chemotherapy should be at least to provide improvement in symptoms and survival of patients. Different types of chemotherapy protocols can be applied in advanced stages of lung cancer, although the typical treatment system is, to apply the combination of platinum with third generation drugs. There is several type of platinum and third generation drugs combinations, but the best combination is not clear. There were 4 different types of combinations containing platinum therapy (gemcitabin/cisplatin, paclitaxel/carboplatin, etoposid/cisplatin and docetaxel/cisplatin) applied in advanced stages (stage IIIB, stage IV), with ECOG PS 0-1, to 91 patients in total. Two kinds of side effects of the treatment are considered as the hematological and non-hematological side effects. Response rates and effectiveness of the treatment also were evaluated by analysis of survival. Statistically there is no significant difference observed at progression free survival and overall survival of patients. On the other hand, in 1 year survival rates docetaxel/cisplatin treatment is more superior than gemcitabin/cisplatin treatment (p<0.05). There were no significant differences found among the group of non-hematological side effects, in hematological side effects anemia observed more in paclitaxel/cisplatin treatment than etoposid/cisplatin treatment and thrombocytopenic observed more in gemcitabin/cisplatin treatment comparing to other types of treatments. As a result, applying four different platinum combinations to a limited number of patients in our study docetaxel/cisplatin is considered as relatively more efficient than other platinum combinations. In order to determine the optimal treatment protocol for this group of patients have poor prognosis, more number of cases should be included, also the conviction was the realization of prospective studies.

Keywords

• Non small cell lung cancer
• systemic chemotherapy
• cisplatin

Lokal ileri metastatik küçük hücre dışı akciğer kanserlerinde tedavi sonuçları ve farklı kemoterapi rejimlerin karşılaştırılması

Öz

Küçük hücre dışı akciğer kanseri, tüm akciğer kanserlerinin % 70-80’ inden sorumlu olup, kanserler arasında en sık mortalite nedenidir. Tanı anında hastaların yaklaşık % 40-50’si ileri evredir. İleri evre akciğer kanseri sistemik bir hastalık olduğundan, birincil tedavisi sistemik kemoterapidir. Ortalama sadece % 5 hasta tedavisiz bir yıl yaşayabilmektedir. Metastatik akciğer kanserli hastalarda tam iyileşme mümkün olmadığından, kemoterapinin amacı öncelikle en az yan etki ile semptomlarda iyileşme sağlamak ve sağkalımın uzatılması olmalıdır. İleri evre akciğer kanserinde farklı kemoterapi rejimleri uygulanmasına rağmen, genel olarak kabul gören tipik tedavi rejimi platinum ve 3.jenerasyon ilaç kombinasyonlarıdır. Günümüzde farklı platinum ve 3.jenerasyon kombinasyonlarının birbirleri üzerine olan üstünlüğü net değildir. Çalışmamıza platinum içeren 4 farklı kombinasyon tedavileri (gemsitabin/sisplatin, paklitaksel/karboplatin, etoposid/sisplatin ve dosetaksel/sisplatin) uygulanmış, ECOG PS 0-1 olan, ileri evrede (evre IIIB, evre IV) toplam 91 hasta alındı. Tedavilerin yan etkileri, hematolojik olan ve hematolojik olmayan yan etkiler olarak belirlendi. Tedavilerin etkinliği de cevap oranları ve sağkalım analizleri ile değerlendirildi. Çalışma sonucunda kemoterapi rejimleri arasında yanıt oranında, progresyonsuz sağkalımda ve ortalama genel sağkalımda istatistiksel olarak anlamlı fark saptanmazken, 1 yıllık sağkalımda dosetaksel/sisplatin tedavisinin gemsitabin/sisplatin tedavisine oranla avantaj sağladığı tespit edildi (p<0.05). Gruplar arasında hematolojik olmayan yan etkilerde anlamlı fark bulunmazken, hematolojik yan etkilerden anemi; etoposid/sisplatin koluna göre paklitaksel/karboplatin kolunda ve trombositopenide de diğer kollara göre gemsitabin/sisplatin kolunda istatistiksel olarak anlamlı fazla bulundu (p<0.05). Sonuç olarak sınırlı sayıda hastalarla yapılmış çalışmamızda 4 farklı platinum kombinasyon tedavileri içinde dosetaksel/sisplatin kombinasyonu göreceli olarak uygun bir tolerabiliteye ve daha üstün bir etkinliğe sahip olduğu düşünülmüştür. Prognozu oldukça kötü olan bu hasta grubunda optimal tedavi rejiminin belirlenmesi için daha fazla vaka sayısı içeren, prospektif çalışmaların gerçekleştirilmesi kanaatine varılmıştır.

Anahtar Kelimeler

• Küçük hücre dışı akciğer kanseri
• sistemik kemoterapi
• sisplatin

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