Retrospective Clinical Study On Maintenance Treatment In Advanced Non-small Cell Lung Cancer

Objective: This retrospectively study compared the efficacy and adverse events of maintenance therapy in advanced non-small cell lung cancer in our hospital,eventually to provide more reliable guidance for clinical practice.Methods: The patients with stage Ⅳ non-small cell lung cancer who reached partial response or stable disease after 4-6 cycles of first-line chemotherapy in our hospital were included in this retrospectively study for follow-up and observe from January 1,2010 to December 31,2017.Efficacy was evaluated by RECIST version 1.1 criteria and adverse events evaluated by CTCAE version 4.0.Statistical analysis with SPSS 19.0 and GraphPad Prism7 software.The survival time was measured by Kaplan-Meier method,and the log-rank method was used to test the survival difference.Results: At the end of follow-up,a total of 120 patients with advanced non-small cell lung cancer were included in this retrospective study.58 patients in the maintenance treatment group and 62 patients in the observation group;the median age in the maintenance treatment group was 52 years old and the observation group was 53 years old;Maintenance therapy improved the median progression-free survival(2.5 months vs 7.5 months,HR=0.44;95% CI,0.29-0.66;P<0.0001)and median overall survival(10.5 months vs 16.0 months,HR=0.65;95%CI,0.44-0.96;P=0.0247)in patients with advanced NSCLC;Targeted drug maintenance increased median progression-free survival compared with chemical drug maintenance therapy(11.2 months vs 7.2 months,HR=0.44;95% CI,0.26-0.82;P=0.0306);and 5-8 cycles of chemotherapy improved the median PFS in patients with advanced lung cancer compared with 1-4 cycles of chemotherapy(10.3 months vs 7.1 months;HR=2.47;95% CI,1.23-4.97;P=0.0438);the median PFS of squamous cell carcinoma was 7.9 months,and adenocarcinoma was 7.2 months,but there was no significant difference between the two groups(P=0.5285);Similarly,there was no difference between pemetrexed and paclitaxel maintenance.The adverse events after maintenance therapy were mainly bone marrow inhibition,nausea,vomiting,etc.Subgroup analysis found that the age less than 65 years old(HR,0.48;95%CI,0.31-0.74),female(HR,0.61;95%CI,0.39-0.94),left lobe(HR,0.55;95%CI,0.31-0.99),squamous cell carcinoma(HR,0.32;95%CI,0.15,0.68),1-2 metastases(HR,0.59;95%CI,0.38,0.93)may benefit from maintenance treatment.Gender and the use of maintenance therapy are independent factors on overall survival.Women is a prognostic factor in comparison with men,and the use of maintenance therapy is a favorable prognostic factor.Conclusion: Maintenance therapy can significantly improve progression-free survival and overall survival in advanced non-small cell lung cancer;Subgroup analysis showed that patients diagnosed younger than 65 years old,female,left lob,squamous cell carcinoma,1-2 metastasis sites may benefit from maintenance therapy,which does not increase serious adverse events,the majority of patients were tolerable.