Efficacy And Prognosis Of The Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor On52Cases Of Advanced Non-small-cell Lung Cancer

Objective:To explore the efficacy,prognosis,side effects and clinicalfactors affecting sensitivity and prognosis of the epidermal growthfactor receptor tyrosine kinase inhibitor therapy for advancednon-small-cell lung cancer.Methods:Clinical datas of advanced non-small-cell lung cancer whoreceived EGFR-TKI treatment in Fujian Provincial Hospital from January2007to August2012were retrospectively reviewed. Paients efficacy wereevaluated according to the response evaluation criteria in solidtumors(RECIST),and follow up the prognosis by telephone.Cancer tissue wasobtained from patients before EGFR-TKI treatment,and we detect thesetissues EGFR gene mutation.Using the statistical methods to analyze theclinical characteristics,efficacy and prognosis of52cases.Chi-squaretest and Fisher exact test were used to analysed the clinical factorsaffecting patients efficacy.Kaplan-Meier method was used in survivalanalysis.Using Log-rank test to analyze single factor and COX model wasused to analyse multivariate factors for prognosis.Results:1、Clinical features：52cases of advanced non-small-cell lung cancer agesarranged from39to85years old,an average of62.8712.06years，including30males and22females.39cases were scored0-1points usingECOG score standard(75.0%),and the remaining13cases were scored≥2points(25.0%).36patients were non-smokers(69.2%),and the rest of16cases had smoking history(30.8%).Pathologic type of adenocarcinomawere42patients(80.8%),7cases of squamous cell carcinoma(13.5%),onecase of adenosquamous carcinoma(1.9%),and2of large cell lungcancer(3.8%).There were9cases of clinical stage IIIb phase,43of IVphase.30patients accepted gefitinib for target therapy(57.7%),erlotinib in19cases(36.5%),and icotinib in3cases(5.8%).There were18patients without any treatment,accountedfor34.6%.27patients had previously received chemotherapy(51.9%).2had received radiotherapy and chemotherapy (3.8%),4cases foroperation and chemotherapy(7.7%),and the other one foroperation,chemotherapy and radiotherapy in combination(1.9%).Therewere18patients using EGFR-TKI for first-line treatment(34.6%),34forsecond-line and above treatment(65.4%).2、Efficacy：Among52cases of advanced non-small-cell lung cancer afterreceiving EGFR-TKI treatment,one case achieved completeresponse(CR).17patients achieved partial response(PR).21achievedstable disease(SD).And the other13achieved progression disease(PD)according to RECIST standard.The objective response rate and thedisease control rate after administration of EGFR-TKI were34.6%(18/52)and75.0%(39/52),respectively.The disease control rate wassignificantly higher in adenocarcinoma,non-smokers and tumor size<5cm than those in non-adenocarcinoma,smokers and tumor size≥5cm(P<0.05).3、Prognosis：Survival analysis indicated that the median progressionfree survival time of52advanced non-small-cell lung cancer patientswas6months,and the median overall survival time was18months.Log-rank test suggested that the median progression survivalwas significantly longer in tumor size <5cm and stable disease patientsthan those in tumor size≥5cm and progression disease(P<0.05).Themedian survival time was significantly longer in non-smokers andpatients of tumor size <5cm than those in smokers and patients of tumorsize≥5cm(P<0.05).COX regression analysis showed that efficacy wasan independent factor of PFS.4、EGFR gene mutation results：6patients cancer tissues were detected for EGFR gene mutation among these52patients of advancednon-small-cell lung cancer.The results suggest that5patients tissues exist gene mutation,the other one was wild-type.2cases occur19exon deletion mutation.2cases occur21exon L858R pointmutation.one patient exists19exon deletion mutation and21exon L858Rpoint mutation.5patients of EGFR gene mutation wereadenocarcinoma,and the other one whose gene result was wild-type wassquamous carcinoma.Among5patients of gene mutation,3cases achievedpartial response(PR) after receiving EGFR-TKI.one case achievedstable disease(SD),and the other one achieved progressiondisease(PD).The wild-type patient achieved stable disease(SD).Conclusion:1、 EGFR-TKI is effective and safe in the treatment of advancednon-small-cell lung cancer patients.Adenocarcinoma,nonsmokers andsmall lesions are beneficial factors of EGFR-TKI in treatment ofadvanced non-small-cell lung cancer.2、 Survival analysis indicate that tumor size,efficacy and smokinghistory are related with prognosis. COX regression analysis show thatefficacy is an independent factor of PFS.3、 Response rate to EGFR-TKI in the patients with EGFR gene mutationmay be higher than in those with wild-type.But these results requirea larger number of study to confirm further.