The Efficacy Comparison Of Icotinib And Gefitinib In Stage Ⅳ Lung Adenocarcinoma Patients With EGFR Sensitive Gene Mutation

Lung cancer in the world has a high morbidity, mortality, the incidence is higher in our country. Non-small cell lung cancer(NSCLC) accounts for about 80-85% of lung cancer. NSCLC patients Treatment options for early surgical treatment, neoadjuvant chemotherapy, adjuvant chemotherapy, radiotherapy and molecular targeted therapy. For phase I, Part II or IIIA NSCLC patients can be used as the first choice, in addition to the IA stage, chemotherapy has a certain value in operation before and after chemotherapy can improve the resection rate. For patients with stage IIIB and stage NSCLC IV, if the patient’s physical state(PS) score<2, chemotherapy can prolong the survival time and improve the quality of life. But Chemotherapy is 50-70% of the patients with easy recurrence, and poor response, survival period is short, so for patients cannot tolerate chemotherapy treatment, targeted therapy become a good choice. NSCLC have higher EGFR mutation probability, according to reports in the literature the expression of the gene mutation associated with poor prognosis. In patients with non-small cell lung cancer with 10-30% of the EGFR gene mutation. Asian people do not smoke or fewer smokers higher mutation rate, at 60%. While Asian adenocarcinoma patients mutation rate up to 51.4%. EGFR-TKI type singel medicine is recommended for the second and third tier without screening patients with standard treatment. Icotinib(Kai Meina)is China’s home-grown another high specificity of epidermal growth factor receptor tyrosine kinase inhibitors.Research in vivo and in vitro have shown the NSCLC has obvious inhibitory effect[5], especially for adenocarcinoma.This study aims to through the clinical observed treatment efficacy and safety Forthe comparison in 36 cases of patients with advanced lung adenocarcinoma using Icotinib and Gefitinib.TKI targeted drugs(Icotinib and Gefitinib)under different state of EGFR mutations treatment efficacy correlation, provide patients with better treatment options.Research purpose: To compare with advanced lung adenocarcinoma in EGFR sensitive mutation positive patients treated with EGFR-TKIs after treatment for 4 weeks Orr and DCR and began to oral administration of the two target to drugs after first appeared in the progression of the disease which had a median PFS of whether there is a difference, and adverse reaction of difference.The research methods: Statistical through the cell or pathologic biopsy or fine needle biopsy diagnosed with late stage IV adenocarcinoma of the lung in 36 patients at Bethune first hospital of jilin university, the time from 2013 to 2014.Extracted into the group of cases according to the requirement of the medical record data, including patient sex, age, smoking, types of EGFR gene mutation, and the curative effect of the medicine and the survival time and so on. Icotinib group 18 cases, gefitinib group 18 cases, Treatment group using Icotinib in the treatment of 125 mg, 3 times/day of oral, control group using gefitinib in the treatment of 250 mg, 1 time/day of oral, the first months of routine pulmonary CT observation of tumor lesions, evaluation of efficacy, followed every 2 months to assess the efficacy of the disease progression, and evaluate its curative effect, record the curative effect and progression-free surial. Comparison of gefitinib and icotinib in the presence of EGFR mutations in advanced lung cancer patients with different treatment,and Therapeutic effects of different EGFR gene mutation type,The primary endpoint was progression of the disease.the test data input SPSS17.0 statistical analysis software for Fisher test; using Kaplan-Meier method to test group and control group werecompared between survival and draw survival curves, differences between groups using log-rank test, P<0.05 said the difference was statistically significant.Result:(1) Detection of EGFR gene of 36 cases were positive patients with advanced lung adenocarcinoma, using icotinib adenocarcinoma patients, disease control rate and efficiency of gefitinib in patients with adenocarcinoma is similar to that of no statistical significance(P=0.899>0.05). The median progression free survival(PFS) was 13 months, range(8.8~17months); gefitinib group with a median progression free survival(PFS) for 10 months(range 6.9~13months); there was no significant difference between the two groups(P=0.386>0.05).(2) gefitinib treated and gefitinib treated in different clinical and pathological characteristics of median PFS compared. It is found that gender, age, smoking, three subgroups which had a median PFS of no significant difference, P value was >0.05.(3) EGFR 19 gene deletion mutation in patients with stage IV lung adenocarcinoma, found Eck for Nigeria in the treatment group with Kyrgyzstan to non imatinib treatment group progression free survival difference was not statistically significant(P>0.05).(4) EGFR21(L858R) point mutation in patients with stage IV lung adenocarcinoma and finds a icotinib sunitinib group median PFS time longer than gefitinib for sunitinib group had a median PFS of time(12 months and 9 months), the difference was statistically significant(P<0.05).(5) Icotinib group and gefitinib group, The adverse reaction of two groups of patients with skin rash, dry skin, diarrhea, nausea, vomiting and the P values are greater than 0.05, the difference was not statistically significant.Conclusion:(1) for patients with stage IV lung adenocarcinoma of EGFR sensitive gene mutations,There was no significant difference in the curative effect of icotinib and gefitinib.(2) for patients with stage IV lung adenocarcinoma of EGFR sensitive gene mutations, gender, age, whether smoking are not the key factor affecting the curative effect.(3) for patients with stage IV lung adenocarcinoma of EGFR 19 gene deletion mutations, There was no significant difference in the curative effect of icotinib and gefitinib.(4) for patients with stage IV lung adenocarcinoma of EGFR21(L858R) point mutations, icotinib is better than gefitinib in Progression-free survival.(5) for patients with stage IV lung adenocarcinoma of EGFR sensitive gene mutations,icotinib and gefitinib have similar safety.