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

Year 2020, Volume: 3 Issue: 3, 239 - 253, 31.12.2020

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.

References

  • World Health Organization. Lung cancer. Available at:http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed August 11, 2018.
  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.
  • Fidaner C, Eser SY, Parkin DM. Incidence in Izmir in 1993-1994: first results from Izmir Cancer Registry. Eur J Cancer. 2001;37(1):83-92.
  • Mao Y, Yang D, He J, et al. Epidemiology of Lung Cancer. Surg Oncol Clin N Am. 2016;25(3):439-445.
  • Friedlaender A, Banna GL, Buffoni L, et al. Poor-Performance Status Assessment of Patients with Non-small Cell Lung Cancer Remains Vague and Blurred in the Immunotherapy Era. Curr Oncol Rep. 2019;21(12):107.
  • Bahij R, Jeppesen SS, Olsen KE, et al. Outcome of treatment in patients with small cell lung cancer in poor performance status. Acta Oncol. 2019;58(11):1612-1617.
  • Hensing TA, Peterman AH, Schell MJ, et al. The impact of age on toxicity, response rate, quality of life, and survival in patients with advanced, Stage IIIB or IV nonsmall cell lung carcinoma treated with carboplatin and paclitaxel. Cancer. 2003;98(4):779-788.
  • Bunn PA, Jr. Chemotherapy for advanced non-small-cell lung cancer: who, what, when, why? J Clin Oncol. 2002;20(18 Suppl):23S-33S.
  • Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by the American Society of Clinical Oncology. J Clin Oncol. 1997;15(8):2996-3018.
  • Manegold C, Bergman B, Chemaissani A, et al. Single-agent gemcitabine versus cisplatin-etoposide: early results of a randomised phase II study in locally advanced or metastatic non-small-cell lung cancer. Ann Oncol. 1997;8(6):525-529.
  • Hotta K, Matsuo K, Ueoka H, et al. Meta-analysis of randomized clinical trials comparing Cisplatin to Carboplatin in patients with advanced non-small-cell lung cancer. J Clin Oncol. 2004;22(19):3852-3859.
  • Arrdizzoni A, Tiseo M, Boni L et al. CISCA (cisplatin vs. carboplatin) metaanalysis: An individual patient data meta-analysis comparing cisplatin versus carboplatin-based chemotherapy in first-line treatment of advanced non small cell lung cancer. J Clin Oncol 2006;24:7011.
  • Belani CP, Lee JS, Socinski MA, et al. Randomized phase III trial comparing cisplatin-etoposide to carboplatin-paclitaxel in advanced or metastatic non-small cell lung cancer. Ann Oncol. 2005;16(7):1069-1075.
  • Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346(2):92-98.
  • Sandler AB, Nemunaitis J, Denham C, et al. Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2000;18(1):122-130.
  • Cardenal F, Lopez-Cabrerizo MP, Anton A, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 1999;17(1):12-18.
  • van Moorsel CJ, Pinedo HM, Veerman G, et al. Mechanisms of synergism between cisplatin and gemcitabine in ovarian and non-small-cell lung cancer cell lines. Br J Cancer. 1999;80(7):981-990.
  • Jensen PB, Holm B, Sorensen M, et al. In vitro cross-resistance and collateral sensitivity in seven resistant small-cell lung cancer cell lines: preclinical identification of suitable drug partners to taxotere, taxol, topotecan and gemcitabin. Br J Cancer. 1997;75(6):869-877.
  • Scagliotti GV, De Marinis F, Rinaldi M, et al. Phase III randomized trial comparing three platinum-based doublets in advanced non-small-cell lung cancer. J Clin Oncol. 2002;20(21):4285-4291.
  • Le Chevalier T, Scagliotti G, Natale R, et al. Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer. 2005;47(1):69-80.

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

Year 2020, Volume: 3 Issue: 3, 239 - 253, 31.12.2020

Abstract

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.

References

  • World Health Organization. Lung cancer. Available at:http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed August 11, 2018.
  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.
  • Fidaner C, Eser SY, Parkin DM. Incidence in Izmir in 1993-1994: first results from Izmir Cancer Registry. Eur J Cancer. 2001;37(1):83-92.
  • Mao Y, Yang D, He J, et al. Epidemiology of Lung Cancer. Surg Oncol Clin N Am. 2016;25(3):439-445.
  • Friedlaender A, Banna GL, Buffoni L, et al. Poor-Performance Status Assessment of Patients with Non-small Cell Lung Cancer Remains Vague and Blurred in the Immunotherapy Era. Curr Oncol Rep. 2019;21(12):107.
  • Bahij R, Jeppesen SS, Olsen KE, et al. Outcome of treatment in patients with small cell lung cancer in poor performance status. Acta Oncol. 2019;58(11):1612-1617.
  • Hensing TA, Peterman AH, Schell MJ, et al. The impact of age on toxicity, response rate, quality of life, and survival in patients with advanced, Stage IIIB or IV nonsmall cell lung carcinoma treated with carboplatin and paclitaxel. Cancer. 2003;98(4):779-788.
  • Bunn PA, Jr. Chemotherapy for advanced non-small-cell lung cancer: who, what, when, why? J Clin Oncol. 2002;20(18 Suppl):23S-33S.
  • Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by the American Society of Clinical Oncology. J Clin Oncol. 1997;15(8):2996-3018.
  • Manegold C, Bergman B, Chemaissani A, et al. Single-agent gemcitabine versus cisplatin-etoposide: early results of a randomised phase II study in locally advanced or metastatic non-small-cell lung cancer. Ann Oncol. 1997;8(6):525-529.
  • Hotta K, Matsuo K, Ueoka H, et al. Meta-analysis of randomized clinical trials comparing Cisplatin to Carboplatin in patients with advanced non-small-cell lung cancer. J Clin Oncol. 2004;22(19):3852-3859.
  • Arrdizzoni A, Tiseo M, Boni L et al. CISCA (cisplatin vs. carboplatin) metaanalysis: An individual patient data meta-analysis comparing cisplatin versus carboplatin-based chemotherapy in first-line treatment of advanced non small cell lung cancer. J Clin Oncol 2006;24:7011.
  • Belani CP, Lee JS, Socinski MA, et al. Randomized phase III trial comparing cisplatin-etoposide to carboplatin-paclitaxel in advanced or metastatic non-small cell lung cancer. Ann Oncol. 2005;16(7):1069-1075.
  • Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346(2):92-98.
  • Sandler AB, Nemunaitis J, Denham C, et al. Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2000;18(1):122-130.
  • Cardenal F, Lopez-Cabrerizo MP, Anton A, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 1999;17(1):12-18.
  • van Moorsel CJ, Pinedo HM, Veerman G, et al. Mechanisms of synergism between cisplatin and gemcitabine in ovarian and non-small-cell lung cancer cell lines. Br J Cancer. 1999;80(7):981-990.
  • Jensen PB, Holm B, Sorensen M, et al. In vitro cross-resistance and collateral sensitivity in seven resistant small-cell lung cancer cell lines: preclinical identification of suitable drug partners to taxotere, taxol, topotecan and gemcitabin. Br J Cancer. 1997;75(6):869-877.
  • Scagliotti GV, De Marinis F, Rinaldi M, et al. Phase III randomized trial comparing three platinum-based doublets in advanced non-small-cell lung cancer. J Clin Oncol. 2002;20(21):4285-4291.
  • Le Chevalier T, Scagliotti G, Natale R, et al. Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer. 2005;47(1):69-80.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Güzin Özden 0000-0003-4856-2267

Publication Date December 31, 2020
Acceptance Date December 30, 2020
Published in Issue Year 2020 Volume: 3 Issue: 3

Cite

APA Özden, G. (2020). Lokal ileri metastatik küçük hücre dışı akciğer kanserlerinde tedavi sonuçları ve farklı kemoterapi rejimlerin karşılaştırılması. Journal of Cukurova Anesthesia and Surgical Sciences, 3(3), 239-253.

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