The Comparable Study Of Icotinib And Erlotinib In The Treatment Of Advanced Non-Small Cell Lung Cancer

Objectives:Icotinib and Erlotinib are two of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) that are used to treat non-small cell lung cancer. The first EGFR-TKIs are reversible EGFR tyrosine kinase inhibitors, such as Gefitinib、 Erlotinib and Icotinib, which are widely used. Icotinib is the first molecular drug developed in China for targeted therapy of lung cancer patients produced by Zhejiang Beida Pharmaceutical Company. So far, clinical comparable studies between Gefitinib and Icotinib, Gefitinib and Erlotinib had been done, whereas there is no clinical comparable study between Icotinib and Erlotinib. EGFR-TKIs have similar structure and anti-neoplastic activity, however the anti-cancer effect is different. To select the better drugs,this study retrospectively analyzed the clinical application of Icotinib and Erlotinib in the treatment of advanced non small cell lung cancer (stage IIIB/IV).The efficacy and side effects of Icotinib and Erlotinib are compared.Methods:Patients were treated in the Second Hospital Affiliated to Dalian Medical University from September 1,2011 to August 31,2013, they were confirmed by pathology for advanced non-small cell lung cancer (stage is ⅢB and Ⅳ).Among them, 27 patients took Icotinib three times a day,125mg each time,33 patients took Erlotinib 150mg once a day. One month later, curative effect was evaluated until progression disease or non stand adverse events happen. Patients were divided into groups based on sex, smoking history, pathological type, metastatic sites, EGFR detection, the number of past therapy, x2 test, rank and inspection Kaplan Meier were used for survival analysis in SPSS 17.0.Results:1. There is no CR patient in either Icotinib group or Erlotinib group. In Icotinib group, the curative effect is 7 PR cases,15 SD cases and 5 PD cases. The objective response rate is 26%, and the disease control rate is 81%; In Erlotinib group, the curative effect is 8 PR cases,20 SD cases and 5 PD cases, the objective response rate is 24%, and the disease control rate is 85%. There is no significant difference between the two groups in ORR and DCR(p=0.881, p=0.723).2. There is no significant difference between Icotinib and Erlotinib groups in same gender, smoking history, pathological type, EGFR detection. The efficacy is equal between Icotinib and Erlotinib. Erlotinib had better response in patients who are first-line target therapy or brain metastases compared to Icotinib.3. In Icotinib group and Erlotinib group, there is significant difference in female、no smoking、EGFR mutation compared with male、smoking、EGFR mutation is unknown. In Icotinib group,there is no significant difference in pathological type, the number of past therapy and metastatic sites. In Erlotinib group, there is no significant difference in pathological type.4. The most common adverse event is skin rash, followed by diarrhea and liver function damage in addition to interstitial pneumonia. In Icotinib group,7 cases (26%) experienced skin rashes, while there are 14 cases (42%) in Erlotinib group. In Icotinib group,4 cases (15%) experienced diarrhea while there are 13 cases (39%) in Erlotinib group, there is significant difference between the two groups in adverse events of diarrhea (p=0.032). One patient have to stop use Icotinib because of Ⅲ grade skin rashes, another Ⅱ grade diarrhea.One patient can’t stand Ⅲgrade skin rashes and Ⅲ grade diarrhea. Meanwhile,2 patients have to stop use Erlotinib because of III grade skin rashes, diarrhea and liver function damage. There are no interstitial pneumonia and other serious adverse events in two groups.Conclusions:The efficacy of Icotinib and Erlotinib is equal. The efficacy is significant different in patient who is female, adenocarcinoma, no smoking and EGFR mutation;In Erlotinib group, efficacy is better in patient with first-line therapy or brain metastases, Icotinib is inferior to Erlotinib in adverse events.