Efficacy And Predictors Of 178 Advanced Non-small Lung Cancer Patients Undergoing Different Second-line Chemotherapeutic Regimens

Objective:The purpose of this study is to illuminate the efficacy and predictors of second-line chemotherapy in advanced non-small cell lung cancer patients and suggest the available protocols that are suitable for differently characterized patients. Methods:A retrospective analysis of the clinical data of 178 advanced NSCLC patients second-line treated in Tianjin Cancer Hospital from 2009.1.1 to 2013.12.31 was performed; according to the different second-line treatments, they were divided into standard mono-drug therapy group(46 cases), endostar combined with standard mono-drug therapy group(42 cases), and platinum based doublet chemotherapy group(90 cases). Kaplan-Meier and Log-rank analyses were used to estimate and compare the survival rates in groups, and Cox`s hazard regression model was used to determine the prognostic factors. Chi-square test was used to detect the difference of frequencies among different groups. Results:Median progression free survival(mPFS) was 50 days, 54 days, and 79 days(P=0.042) in standard mono-drug therapy group, endostar combined with standard mono-drug therapy group, and Platinum based doublet chemotherapy group, respectively. The differences between the mono-drug therapy group and doublet chemotherapy group were statistically significant(P=0.011). The disease control rate(DCR) for each group was 26.1%, 47.6% and 46.7%, and the DCR were statistically significant between mono-drug therapy group and doublet chemotherapy group(P=0.016), and endostar combined with standard mono-drug therapy group(P=0.041), but not significant between endostar combined with standard mono-drug therapy group and doublet chemotherapy group(P=0.947). The overall response rate(ORR) for each group was 2.2%, 0.0%, and 4.4%, the differences between the three groups were not statistically significant(P=0.071). Multivariate analysis showed that the period from the begin of first-line to second-line chemotherapy(progression-free time), base-line clinical stage, neuron specific enolase(NSE) before second-line, the cycles of second-line chemotherapy and the response to second-line therapy were independent predictors for PFS(P<0.05 for all). Subgroup analysis indicated that the patients obtained more clinical benefit from doublet chemotherapy rather than mono-drug therapy with following factors: age<60 years, paclitaxel plus platinum for first-line treatment, chemotherapy cycles ?4, CR,PR, and SD for response, progression time within 3-6 months from the begin of first-line to second-line chemotherapy, performance status?1 at the begin of second-line therapy, IV stage, mild leukopenia(P<0.05 for all). The patients whose progression-free time within 3-6 months from the begin of first-line to second-line chemotherapy got more clinical benefit from endostar combined with standard mono-drug therapy chemotherapy than mono-drug therapy(P=0.006). Conclusion:The period from the begin of first-line to second-line chemotherapy(progression-free time), base-line clinical stage, neuron specific enolase(NSE) before second-line, the cycles of second-line chemotherapy and the response to second-line therapy were independent predictors for PFS. Platinum based doublet chemotherapy and endostar plus standard mono-drug regimen are able to improve the efficacy in some characterized advanced NSCLC as compared patients by standard mono-drug therapy, wherein the platinum based chemotherapy revealed the best efficacy.