Comparison of efficacy and toxicity of pemetrexed or gemcitabine combined with cisplatin in the treatment of patients with advanced bladder transitional cell carcinoma

Objective To investigate the clinical efficacy and toxicity of pemetrexed combined with cisplatin and gemcitabine combined with cisplatin in chemotherapy for the treatment of advanced bladder transitional cell carcinoma. Methods Seventy-two patients who were diagnosed with advanced bladder cancer in our hospital from March 2012 to December 2015 were enrolled in this study. The patients were divided into two groups by digital randomization method, 36 patients in the observation group which was given pemetrexed sodium combined with cisplatin chemotherapy (PC group) and 36 patients in the control group that was treated with GC regimen(GC group). PC group: pemetrexed 500/m2, day 1. cisplatin 75 mg/m2, day 1. GC group: gemcitabine 1000 mg/m2, day 1, 8, cisplatin 75 mg/m2, day 1. The treatment cycle was once every three weeks. In addition, folic acid, vitamin B12 and dexamethasone were treated in PC groups. After 6 weeks of treatment, the efficacy and adverse reactions of the two groups were compared respectively. Results The total clinical effective rates in PC group and GC group were 82.9% and 80.0% respectively. The median tumor progression time in the PC group and the GC group was 6.9 months and 6.5 months, respectively. The median survival time in the two groups was 14 and 16 months, with 45.7% and 51.4% survival rates of 1 year and 11.4% and 14.3% survival rates of 2 years. There were no significant differences in total clinical effective rates, tumor progression duration, median survival time, and survival rates of 1 year and 2 years between the two groups(P>0.05). From the adverse reactions, the adverse reactions of leukopenia, thrombocytopenia, leukopenic fever and nausea and vomiting in the PC group were significantly lower than those in the GC group, and the difference was statistically significant(P<0.05). Conclusions Pemetrexed and cisplatin is effective in the treatment of advanced bladder cancer with gemcitabine and cisplatin, but the side effects are significantly reduced. It is a safer and more effective chemotherapy regimen, which is more worthy of promotion for aged patients with advanced bladder cancer. Key words: Urinary Bladder Neoplasms; Pemetrexed; Cisplatin; Drug Therapy, Combination