Abstract Objective To observe Cha Jixi Bin cisplatin in the treatment of elderly patients with advanced malignancies clinical efficacy, toxicity, clinical benefit response. Gemcitabine 800mg/m2 intravenously on days 8, 15; of cisplatin 30mg/m2 intravenously 2 to 4 days, 28 days for 1 cycle, evaluated after completion of 2 cycles. At least two treatment cycles. Results 64 cases were available, the total effective rate of 46.9%, 28 cases of non-small cell lung cancer, an effective rate of 46.4%, pancreatic cancer 18 cases, an effective rate of 44.4%, breast cancer 18 cases, an effective rate of 50%, The median survival time was 11 months, time to progression was 6.2 months, and 1-year survival and 2-year survival rates were 43.8% and 23.4%, respectively. Disease-related symptoms significantly improved physical state to improve the rate of 62.5%, the major adverse reactions were myelosuppression and gastrointestinal reactions. No treatment-related deaths. Conclusion Gemcitabine combined with cisplatin chemotherapy in the treatment of elderly patients with advanced malignancies recent higher efficiency. Toxicities were mild and well tolerated and may improve disease-related symptoms, worthy of clinical application.
Key words gemcitabine with cisplatin chemotherapy of elderly patients with advanced malignancies
As people are living longer, the elderly cancer patients gradually increase in chronic diseases of the heart, kidneys, liver, etc. Because the elderly tend to merge, select chemotherapy is very tricky. Gemcitabine, due to its more applicable than the low toxicity and side effects in the treatment of elderly patients. October 2004 to August 2006 our 64 cases of elderly with advanced malignancies in patients using gemcitabine plus cisplatin chemotherapy program treatment achieved better efficacy and toxicity of light, disease-related symptoms improve significantly, improved quality of life, now The report is as follows.
1 Materials and Methods
1.1 General Information
64 patients, male 38 cases, female 26 cases, aged 65 to 87 years old, with a median age of 71 years. 28 cases of non-small cell lung cancer, 18 cases of breast cancer, pancreatic cancer, 18 cases, all cases were newly diagnosed cases and confirmed by histopathology and (or) cytology, and has lost the chance of radical surgery. The whole group underwent chemotherapy before liver and kidney function and tumor markers matter of CA153 in the. Stage patients with breast cancer, CA199 checks have measurable disease to assess efficacy.
1.2 The method of administration
Gemcitabine 800mg/m2 intravenous infusion of 30 ~~ 60min, d1, 8,15, cisplatin 30mg/m2 intravenous d2 ~~ 4 hydration diuretic, 28 day cycle. All patients were given conventional antiemetic granisetron 3mg, 30 min before chemotherapy infusion. The patients were evaluable for response after 2 cycles of chemotherapy. Line blood count, liver and kidney function tests a week after treatment.
1.3 Evaluation Criteria
1.3.1 clinical efficacy the recent the objective efficacy evaluation WHO1981 uniform standards are divided into: complete remission (CR), partial remission (PR), stable (SD) and progress (PD). Survival, calculated from the date of initial treatment in remission from the remission date to tumor progression or appearance of new lesions.
1.3.2 Clinical benefit response assessment of pain, physical condition and body weight change. Decrease in analgesic consumption ≥ 50%; physical improvement: markedly: activity to improve ≥ 2 differential;: activity improved ≥ 1 differential; invalid: activity <1 differential or diminished. ECOG score: 0: activity completely normal without any difference, before the onset of activity; 1: able to move around freely and engage in light physical activity; including general housework or office work, but can not engage in heavy physical activity; 2 level: able to move around freely and self-care, but has lost the ability to work during the day at least half the time you can get up activities; 3: life can only be part of the self-care during the day for more than half of the time in bed or a wheelchair; 4: bed not since life can not take care of themselves. Improvement rate: Markedly + The valid cases accounted for a fraction of all cases. Weight gain ≥ 7% above a turn for the better and lasts a month or more indicators.
1.3.3 toxic side effects WHO anticancer drug toxicity indexing standards are divided into 0 ~ Ⅳ degrees.
2.1 clinical efficacy
Accumulated in the group of 64 patients completed chemotherapy 256 cycles. The total efficiency of 46.9%, as shown in Table 1. Follow-up rate of 100%, the longest follow-up period of 32 months. The median survival time was 11 months, time to disease progression was 6.2 months, and the 1-year survival rate was 43.8% (28/64), 2-year survival rate was 23.4% (15/64). Table 1 gemcitabine Bin joint cisplatin chemotherapy in the treatment of elderly patients with advanced malignant tumors
2.2 physical condition to improve the situation
Gemcitabine plus cisplatin chemotherapy can significantly improve the quality of life of elderly patients with advanced tumors. 32 cases of pain reduction or disappearance of pain relief was 50.0%. Physical condition after chemotherapy by four rising 2 for two cases, one of the three rising for six cases rose to three of the four of the 10 cases, three rose 2 to 12 cases two rising 1 to 10 cases. The improvement rate was 62.5%. The weight improvement rate was 37.5%, as shown in Table 2. Table 2 gemcitabine Bin plus cisplatin chemotherapy in the treatment of elderly patients with advanced malignancies physical condition to improve the situation
Gemcitabine plus cisplatin chemotherapy toxicities were hematologic toxicity, Ⅲ ~~ IV thrombocytopenia reduce the incidence of 26.6%, leukopenia incidence of 25.0%. Other reactions were mild, as shown in Table 3. Table 3 gemcitabine plus cisplatin chemotherapy in the treatment of elderly patients with advanced malignant bone marrow suppression reaction
Elderly cancer patients in recent years been concerned about their physical hypogonadism, decreased liver and kidney function, bone marrow regeneration and functional reserve weakening lead to the body adverse drug changes significantly different from the young and middle-aged, elderly cancer patients should be smallest effective chemotherapy adverse reactions and quality of life in an important position. Gemcitabine is an anti-tumor drug in the 1990s, the case of the cell cycle-specific anti-metabolic drugs. In recent years, laboratory studies have shown that, Gemcitabine and Cisplatin on a variety of cultured human tumor cells with a high degree of anti-tumor synergy . Treatment of non-small cell lung cancer rate was 35% to 54%, the highest two-year survival rate in combination with cisplatin, gemcitabine, neutropenia febrile significantly reduced . Gemcitabine is a priority for the treatment of elderly patients with advanced non-small cell lung cancer . And combination chemotherapy for pancreatic effective solution FAM (ADM, MMC, 5 Fu), GP (GEM, DDP). Gemcitabine ovarian cancer, breast cancer and other anticancer activity. Foreign study of gemcitabine and cisplatin combination therapy had recurrence of breast cancer chemotherapy, the effective rate of 26% to 50% [4,5]. The group of 64 patients, the treatment of non-small cell lung cancer an effective rate of 46.4%, similar with the literature, effective rate was 44.4% in the treatment of pancreatic cancer, breast cancer and 50.0%, suggesting that gemcitabine-based combination chemotherapy compared with good effect. This group after chemotherapy to reduce tumor-related symptoms, physical condition significantly improved physical condition to improve the rate of 62.5%, pain relief, quality of life has been markedly improved. The median survival period be extended. The main toxicity was hematologic toxicity, mainly as platelets and white blood cells to reduce other mild and easily tolerated. The present study demonstrates that gemcitabine combined with chemotherapy in the treatment of advanced malignancies is safe and has a good effect, and can reduce symptoms, improve quality of life, better choice for the clinical treatment of elderly cancer.