Study On The Law Of Syndrome Evolution And Treatment Based On Syndrome Differentiation In Patients With EGFR-TKIs Treated By Molecular Targeted Therapy Of Lung Cancer

Purpose:Through prospective clinical studies,we summarized and analyzed the evolution of symptoms of lung cancer molecular targeted therapy for EGFR-TKIs,the prescription rules of TCM differentiation and treatment,and evaluated the therapeutic efficacy of TCM dialectical therapy,in order to improve the overall efficacy of TCM combined with molecular targeted therapy for lung cancer EGFR-TKIs.Method:Data were collected from patients with EGFR-sensitive mutations of lung cancer who visited the outpatient clinic and hospitalized in the ward of Guanganmen Hospital,China Academy of Chinese Medical Sciences.According to the "Guidelines for the Diagnosis and Treatment of Non-small Cell Lung Cancer" of the Chinese Society of Clinical Oncology(CSCO),patients in the treatment of EGFR-TKIs for lung cancer are divided into three different treatment stages:initial stage,stable stage of treatment and stage of acquired drug resistance.Cluster analysis was used to summarize the evolution of medical syndrome in lung cancer patients.The method of scaleless network analysis was used to explore the rules of prescription and medication in lung cancer patients.To evaluate the clinical efficacy of traditional Chinese medicine combined with EGFR-TKIs.Results:1.Baseline situation:A total of 211 lung cancer patients who met the criteria for inclusion were enrolled,including 180 lung cancer patients treated with EGFR-TKIs and 31 lung cancer patients before EGFR-TKIs treatment.Among them,136 cases were female,accounting for 64.45%.and 75 cases were male,accounting for 35.55%;The age range of patients ranged from 26 to 87 years,with a mean age of 59.94±9.57 years;56 patients had a history of smoking(including secondhand smoke),accounting for 26.54%;There were 36 patients with family genetic history,accounting for 17.06%;The distribution of pathological types showed 189 cases(89.57%)of adenocarcinoma,11 cases(5.21%)of squamous cell carcinoma,7 cases(3.32%)of adenosquamous cell carcinoma,and 4 cases(1.90%)of other rare types.Stage Ⅳ.was concentrated in 191 cases(90.52%),followed by 15 cases(7.11%)in stage Ⅲ.A and 5 cases(2.37%)in stage Ⅲ.B.The distribution of EGFR mutation types was exon 21 point mutation(56.87%).exon 19 deletion mutation(38.39%),and T790M mutation(4.74%).2.Symptom research part:(1)The medical evidence of lung cancer patients before EGFR-TKIs treatment was mainly spleen and lung qi deficiency(35.48%),followed by spleen deficiency and phlegm wet evidence(29.03%),qi and yin deficiency evidence(19.36%),qi deficiency blood stasis(9.68%)and moist heat evidence(6.45%).(2)In the initial stage of treatment,there were 13 cases of medical evidence of wind and heat table deficiency,accounting for 28.89%,11 cases of humid heat connotation,accounting for 24.45%,followed by 10 cases(22.22%)of spleen and lung qi deficiency,6 cases(13.33%)of qi and yin deficiency,and 5 cases of yin deficiency and blood stasis(11.11%).(3)Among patients with stable stage of lung cancer,the medical evidence type was mainly yin deficiency and heat toxicity,with 37 cases,accounting for 52.11%,followed by 15 cases(21.13%)of qi-yin deficiency,10 cases(14.09%)of spleen-lung qi deficiency,9 cases(12.67%)of sputum and stasis.(4)Among patients with lung cancer in the stage of acquired drug resistance,the medical evidence type was mainly lung and kidney deficiency and sputum and stasis toxicity,with 29 cases,accounting for 45.31%of the total number of cases,followed by qi and yin deficiency and sputum and stasis toxicity,with 15 cases,accounting for 23.44%,followed by 10 cases(15.62%)of yin deficiency and heat toxicity,6 cases of spleen and lung qi deficiency(9.38%)and 4 cases of sputum and stasis(6.25%).3.Research on the law of dialectical treatment of medicine in traditional Chinese medicine;(1)The core prescription in the initial stage of treatment is ground skin seed,white fresh skin,white cardamom,kudzu,kojia meat,angelica,red peony,forsythia,codonopsis,astragalus,burdock seed,sand ginseng,Mai Dong,the five flavors of the drug are mainly bitter,bitter and sweet,the four qi are mostly cold,mainly attributed to the lungs,stomach and spleen,and the drug effect is to clear heat,detoxify,dispel wind,relieve itching,nourish jin,reduce swelling,stop diarrhea,etc.(2)The core prescription of the stable stage of treatment is mulberry white skin,ground bone skin,Zhejiang fritillary,bitter almond,sand ginseng,Maidong,dragon kwai,Baiying,zhimu,Xuan ginseng,astragalus,raw ground yellow,licorice,the four qi of the drug are the most cold,the five flavors are mainly sweet and bitter,mainly attributed to the lungs,stomach,liver meridian,The efficacy of the drug is to clear heat,detoxify,nourish yin,reduce swelling,cool blood,diarrhea lungs,and rejuvenate,etc.(3)The core prescription for the treatment of acquired drug resistance stage is golden buckwheat,summer subtilis,Zhejiang fritillary,cordyceps,codonopsis,huangjing,eucommia,wheat dong,sand ginseng,astragalus,rhodiola,tarragon,Baiying,the four qi of the drug are cold,flat and warm,the five flavors are mainly sweet and bitter,mainly attributed to the lungs,liver,stomach,kidney,spleen,the efficacy of the drug is to clear heat,detoxify,benefit the lungs,dissolve stasis,reduce swelling,disperse knots,strengthen the spleen,dissolve phlegm,promote dampness,nourish yin,and benefit the kidney.4.Differentiation evaluation of therapeutic efficacy in patients with EGFR-TKIs with lung cancer:(1)Quality of life(FACT-L scale)score:the difference in physiological condition,emotional condition,functional status,additional attention,and quality of life total scores were statistically significant(P<0.05)after TCM treatment in the initial stage of treatment,treatment stability stage and treatment acquisition resistance stage.The improvement rate of FACT-L scale scores in lung cancer patients after TCM treatment was 39.87%,the stable stage of treatment was 46.24%,and the stage of treatment-acquired drug resistance was 21.43%.(2)TCM Syndrome Points:The total scores of TCM syndrome points in the initial stage of treatment,the stable stage of treatment and the stage of treatment-acquired drug resistance were statistically significant after the paired t test before and after TCM treatment(P<0.05).(3)The difference in tumor marker levels before and after the differentiation and treatment of Chinese medicine was not statistically significant(P>0.05),and there were no significant changes in blood routine and liver and kidney function(P>0.05).Conclusions:1.The evolution of the syndrome is that the initial stage of EGFR-TKIs treatment for lung cancer patients is mainly characterized by wind and heat surface deficiency,humid heat connotation and spleen and lung qi deficiency;The symptoms in the stable stage of EGFR-TKIs treatment were mainly Yin deficiency and heat toxicity.In the stage of acquired drug resistance in the treatment of EGFR-TKIs,lung and kidney deficiency,sputum and stasis deficiency,qi and yin deficiency,and sputum and stasis were more common.2.The dialectical treatment prescription medication rule is EGFR-TKIs,and the initial stage of treatment is mainly to dispel wind and heat,strengthen the spleen and dampness;The treatment of EGFR-TKIs in the stable stage is mainly based on nourishing yin,clearing heat and detoxification;EGFR-TKIs treatment of acquired drug resistance mainly focuses on strengthening the spleen and kidney,invigorating qi and nourishing yin,dissolving phlegm,removing stasis and detoxification.3.TCM differentiation and treatment can improve the quality of life of patients with EGFR-TKIs with lung cancer.