Abstract Objective To observe the feasibility of Gemzar and carboplatin efficacy and side effects of the treatment of patients 70 years and older with advanced non-small cell lung cancer (NSCLC) to evaluate the program. Methods A retrospective analysis of 44 patients with gemcitabine and carboplatin chemotherapy in patients with advanced NSCLC (naive), including 70 under the age of 24 cases, 20 cases over 70 years old. Chemotherapy: 70-year-old Jian Optional 1 200 mg/m2, d1, 8; carboplatin AUC = 5, d1; ≥ 70 years of age gemcitabine and 000 mg/m2, d1, 8; carboplatin AUC = 4, d1,. Repeated every three weeks, at least 2 cycles of treatment, evaluated after two weeks. 70 years of age group completed a total of 89 cycles of chemotherapy, an average of 3.7 cycles response rate (CR + PR) 45.8%, the group completed a total of 66 cycles over the age of 70, an average of 3.3 cycles response rate (CR + PR) was 40.0%, the two groups efficient difference was not statistically significant (P> 0.05). Two groups Ⅲ ~ Ⅳ bone marrow suppression, severe nausea, vomiting, hair loss, liver and kidney dysfunction, the difference was not statistically significant (P> 0.05), under the age of 70 group 1 cases of severe constipation, five cases of 70-year-old group, the difference was statistically significance (P <0.05). The two groups were 2 patients with chemotherapy-induced thrombocytopenia was significantly higher occurrence of deep vein thrombosis of the lower limbs, 1 case of 56-year-old male patient improved after anticoagulant therapy. Conclusion Gemzar combined with carboplatin chemotherapy in advanced NSCLC over the age of 70, the efficacy, toxicity can be tolerated.
Key words non-small cell lung cancer and health carboplatin in elderly patients
Whether the 70-year-old and older patients with advanced NSCLC chemotherapy, has been controversial, the majority of older people diagnosed with lung cancer in late, and can only be carried out chemoradiotherapy. With the new chemotherapy drugs, the constant introduction of chemotherapy, chemotherapy-induced side effects compared with the previous significantly reduced, more and more common in elderly patients receiving chemotherapy. The period from January 2005 to January 2007, we retrospectively analyzed in our hospital Gemzar plus carboplatin chemotherapy 44 patients with advanced NSCLC cases divided by age group below 70 years of age and more than 70-year-old group ( receive 2 cycles of chemotherapy including 70-year-old), in all cases, as the primary efficacy standard chest X-ray or chest CT measurable lesions, comparing the efficacy and side effects are as follows.
1 Materials and Methods
1.1 Clinical data
All patients underwent fiberoptic bronchoscopy or transthoracic needle biopsy with NSCLC. <70 age group of 24 patients, 19 males and 5 females; aged 34 to 69 years, with a median age of 58 years old; including two cases of adenocarcinoma in 14 cases, seven cases of squamous cell carcinoma, large cell carcinoma, mixed cell carcinoma ; TNM stage: Ⅲ b, 13 cases of 11 cases, Ⅳ. ≥ 70 age group of 20 patients, 15 males and 5 female patients; aged 70 to 76 years, with a median age of 72 years; 11 cases, including adenocarcinoma, squamous cell carcinoma, large cell carcinoma, 2 cases of mixed cell carcinoma , TNM stage: Ⅲ b period 11 cases, Ⅳ stage nine cases. Complained of cough, bloody sputum, bone pain admission the most common. The two groups of patients with KPS score ≥ 60 points, expected survival ≥ 3 months. Liver and kidney function is normal. All patients completed 2 cycles and more chemotherapy, ≥ 4-month follow-up.
<70-year-old group, gemcitabine 1 200 mg/m2 + saline 100 ml intravenous infusion of 20 min, d1, 8; carboplatin AUC = 5 intravenous infusion, d1; 70-year-old group, gemcitabine 1 000 mg/m2 + physiological saline 100 ml intravenous infusion for 20 min, d1, 8; carboplatin AUC = 4 infusion d1 21 days as a cycle, each patient at least 2 cycles of chemotherapy, the routine use of the 5 HT3 receptor antagonist preventive ended spit therapy, chemotherapy during the weekly review of the 2 blood count, white blood cell is less than 2.5 x 109 / L given G CSF treatment.
1.3 Evaluation Criteria
Efficacy according to WHO unified judgment about the solid tumor evaluation criteria, divided into complete remission (CR), partial remission (PR), stable (SD) and progress (PD); CR + PR effectively. Toxicity acute and subacute toxicity evaluation criteria are divided into 0 ~ Ⅳ according to WHO. Toxicity evaluation every two weeks to evaluate the efficacy of every 2 cycles of treatment, no significant difference between two groups.
1.4 statistical methods
SPSS10.0 statistical software χ2 test.
2.1 clinical efficacy
The 70-year-old group completed a total of 89 cycles of chemotherapy, and an average of 3.7 cycles of chemotherapy. ≥ 70 years of age group completed 63 cycles of chemotherapy, an average of 3.3 cycles of chemotherapy, as shown in Table 1. Table 1 two sets of chemotherapy term efficacy comparison
The toxicity of the two groups are lighter, no grade Ⅳ adverse reactions, no treatment-related deaths. Myelosuppression, nausea and vomiting, constipation in ≥ 70 age group the incidence is high, but no Ⅳ myelosuppression and nausea and vomiting. ≥ 70-year-old man with severe constipation compared to <70 years of age increased significantly, the need to take a lot of Runchang laxatives, or even glycerin enema enema. Hair loss, liver and kidney toxicity two groups showed no significant differences, as shown in Table 2. Table 2 two sets of side effects of chemotherapy is worth noting that the use of Gemzar plus carboplatin chemotherapy in patients with NSCLC, the two groups were 2 patients with chemotherapy-induced thrombocytopenia was significantly higher, and 1 case of 56-year-old male. 542G / L, cells in cancer patients with chemotherapy-induced thrombocytopenia of occurrence of deep vein thrombosis of the lower limbs, and given the low molecular weight heparin anticoagulant therapy after remission. The other three cases were treated with aspirin, anticoagulant therapy, thromboembolic disease.
With the aging of the population, 70 years of age or older lung cancer incidence and mortality are increasing year by year in the past 70 years of age or older are not suitable for chemotherapy, but the treatment of lung cancer in elderly patients with the improvement of medical standards, a growing concern. ECOG5592 test  ECOG score well over the age of 70 patients with advanced lung cancer, undergoing chemotherapy. Non-small cell lung cancer accounts for 80% of lung cancer, the study showed that elderly patients with NSCLC receiving single-agent [2,3] or platinum  based combination chemotherapy, can improve the quality of life, less toxicity.
 paclitaxel and carboplatin is tolerated chemotherapy ECOG1594 test, but paclitaxel prone to allergies and phlebitis, pretreatment and deep venous catheter, increased insecurity and nursing workload. Lau Luen et al  reported Gemzar, Taxol, Novo CD of this treatment, gemcitabine, paclitaxel fewer side effects than Novo CD this.
Gemzar (gemcitabine) is a new type of synthetic pyrimidine nucleoside analogue, is anti-metabolic class of anti-cancer drugs in the body into the double-fluorodeoxyglucose phosphorus cytidine is incorporated into DNA to fracture, a major role in S phase cell cycle specific drugs , the side effects are relatively small, suitable for elderly patients. Gemcitabine monotherapy in advanced NSCLC efficiency from 18% to 35% , combined with cisplatin (DDP), an effective rate of 30% to 60% . Due to DDP gastrointestinal reactions, nephrotoxicity, ototoxicity greater restrictions in elderly patients, carboplatin toxicity advantage for elderly patients with gemcitabine efficacy of 50.0%  .
Elderly Patients with Advanced NSCLC therapeutic purposes to relieve symptoms and improve quality of life the main functions of the organs is relatively weak, due to many elderly people with underlying diseases, health conditions are quite different, therefore, treatment should be based on the individual circumstances of the patient dose and usage of the adjustment. Depending on age, chemotherapy dose appropriately adjusted, 70-year-old group Gemzar 1 000 mg/m2, carboplatin AUC = 4; 70 years of age group were treated with 200 mg/m2 of gemcitabine and carboplatin AUC = 5 Treatment. 70 years of age group CR + PR (%) 45.8% 40.0% CR + PR (%) 70-year-old group, Comparison of two groups showed no significant difference (P> 0.05). The two sets of side effects such as bone marrow suppression, nausea and vomiting in more than 70 years of age group a higher incidence of serious bone marrow suppression, nausea, vomiting, liver and kidney toxicity no significant differences. More than 70-year-old group of severe constipation incidence increased significantly less than the 70-year-old group, the need for symptomatic treatment. The two groups of patients after chemotherapy Jieyou elevated platelet cases, and past no similar reported. Therefore, the choice of the chemotherapy not only pay attention to thrombocytopenia caused by bleeding disorders should be concerned about thromboembolic disease caused by elevated platelet. The small number of patients with Gemzar platelets increased joint carboplatin, the reasons remain unclear, may be related to NSCLC patients with hypercoagulable states, may be aspirin, low-molecular-weight heparin calcium in the treatment of elevated platelet after chemotherapy.
Influenced by the constitution and the basis of disease in elderly patients with advanced tumors, chemotherapy can not be in accordance with the standard program, but the degree of malignancy of elderly cancer is often better than young people, and influenced by the nutritional status, tumor growth is relatively slow, the effect of chemotherapy common clinical geriatric oncology patients is not worse than the young. Our research shows that Gemzar and carboplatin in the treatment of more than 70 years of age with advanced NSCLC, efficacy and toxic side effects were similar with 70 years of age, KPS score ≥ 60 points in elderly advanced NSCLC patients can be used gemcitabine plus carboplatin chemotherapy.