Clinical Observation Of Anlotinib Combined With Docetaxel In The Treatment Of Advanced Non-small Cell Lung Cancer

Backgroud and Objective:Non-small cell lung cancer accounts for the majority of lung cancer,which is highly invasive and difficult to treat,and is often found in advanced stages.The survival benefits of conventional chemoradiotherapy have reached a plateau.With the progress of medicine,the diagnosis and treatment of non-small cell lung cancer has gradually changed to accurate medical treatment.Abnormalities of cancer-related genes are the root causes of abnormal biological behavior of tumors,such as the epidermal growth factor receptor(epidermal growth factor receptor,EGFR)sensitive mutations,anaplastic lymphoma kinase(anaplastic lymphoma kinase,ALK)rearrangement,etc.Common targeted drugs include epidermal growth factor receptor-tyrosine kinase inhibitors(epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs)such as icotinib,erlotinib,gefitinib and anaplastic lymphoma kinase-tyrosine kinase inhibitors(anaplastic lymphoma kinase-tyrosine kinase inhibitors,ALK-TKIs)such as lauratinib,crizotinib,aletinib,etc.these drugs significantly prolong the survival time of patients.But in the end,the problem of drug resistance cannot be avoided,and patients with gene detection wild-type cannot benefit from targeted therapy.It is well known that angiogenesis plays a key role in the growth,proliferation and metastasis of a variety of solid tumors.Among the pathways that mediate angiogenesis,vascular endothelial growth factor(vascular endothelial growth factor,VEGF)and its receptor(vascular endothelial growth factor receptor,VEGFR)are the most important.Common anti-angiogenic drugs include bevacizumab,anlotinib,etc.large-molecule anti-angiogenic drugs are represented by bevacizumab,and small-molecule multi-target anti-angiogenic drugs are represented by anlotinib,which were all approved by China Food and Drug Administration(CFDA)for the treatment of NSCLC.Anlotinib is a small molecular antiangiogenic drug independently developed in China,It has achieved remarkable curative effect in many kinds of tumors.Some studies have shown that the combination of antiangiogenic drugs and chemotherapy can not only improve the efficacy,but also delay the occurrence of drug resistance.Therefore,the main purpose of this study is to observe the short-term efficacy and safety of anlotinib combined with docetaxel in the second-line treatment of advanced NSCLC.Methods:The electronic medical record system was used to collect the patients with advanced NSCLC diagnosed and treated by Henan people’s Hospital from April 2019 to October 2019.60 patients who met the criteria were selected and the general clinical data of all patients were recorded.60 patients with advanced NSCLC were divided into observation group and control group according to the difference of second-line treatment.The control group was given docetaxel(Jiangsu Hengrui Pharmaceutical Co,Ltd,National Medicine Zhunzi H20020543,20 mg/vessel)75 mg/m~2,intravenously,on the first day,21 days as a chemotherapy cycle.The observation group was orally administered Anlotinib capsules(Zhengda Tianqing Pharmaceutical,National Medicine Zhunzi H20180002,12mg/capsule)on the basis of chemotherapy in the control group,12 mg/time,1 time/d,on the 1st to 14th day,21 days for 1 cycle.Patients in both groups completed at least 4 cycles of treatment.Record the serum level of 60 patients before each cycle of chemotherapy and the imaging results after 2 cycles of treatment,compare and analyze the results.The time from start of treatment to disease progression or death and adverse reactions during the treatment were recorded.SPSS 22.0 software was used to process the data.The measurement data was expressed as mean±standard deviation((?)±s),and the counting data was expressed as a percentage.χ2 test and t test were used for comparison between groups,Kaplan-Meier method was used to draw survival curve,and Cox regression model was used for multivariate analysis.P<0.05 means the difference is statistically significant.Results:1.There was no statistically significant difference between the two groups at baseline.2.After 4 cycles of chemotherapy,the disease control rate in the observation group(86.67%)was higher than that in the control group(60.00%),P=0.020,and the difference was statistically significant.The objective response rate of the observation group(26.67%)was compared with that of the control group(20.00%),P=0.542,and the difference was not statistically significant.3.After 4 cycles of chemotherapy,the serum CEA[(7.25±4.93),(12.28±5.63)μg/L]and VEGF[(56.12±33.69),(102.17±44.94)ng/L]levels of the observation group and the control group were lo wer than that before treatment[CEA:(50.47±13.49),(54.15±12.93)μg/L;VEGF:(407.41±147.32),(411.44±143.56)ng/L](P<0.05),and the observation group were lower than the control group after4 cycles of chemotherapy(P<0.05).4.The median progression-free survival time(4.8 months)in the observation group was longer than that in the control group(2.8 months)(P<0.05).5.During the treatment period,the adverse reactions of the two groups were mostly gradeⅠtoⅡ,which could be tolerated.The incidence of hand-foot syndrome,hypertension and hemoptysis in anlotinib combined with docetaxel group(36.67%、33.33%、13.33%)were higher than those in control group(0、6.67%、0),and the difference was statistically significant.6.Cox multivariate analysis showed that tumor stage,ECOG score were independent risk factors affecting tumor progression or death.Conclusion:Compared with docetaxel,anlotinib combined with docetaxel improved disease control rates and prolonged progression-free survival as the second-line treatment of driver gene-negative advanced NSCLC.Although the adverse reactions of combination therapy increased compared with chemotherapy,they were all common adverse reactions of small molecule antiangiogenic drugs and were tolerated by most of the patients.