| Background and Objective:Lung cancer is one of the most common malignant tumors over the world,The latest cancer data report shows the morbidity and mortality of lung cancer are the highest in China.Brain metastasis is one of the leading cause of death in lung cancer,the survival time will be significantly shortened after brain metastasis,the median survival of a patient only 1-4 months without any treat and the survival was not dramatically prolonged even treat with a standard brain radiotherapy.Targeted therapy for brain metastasis is a hotspot in recent years,and studies have shown that targeted treatment of brain metastases of lung cancer is not inferior even better than conventional radiotherapy.This study retrospectively analyzed Icotinib as first-line treatment for non-small cell lung cancer patients with brain metastasis who harboring a EGFR gene mutation,with the purpose of providing a clinical reference for those patients.Methods:Retrospectively analyzed 118 cases of non-small cell lung cancer with brain metastasis,all these patients were initial treatment and carried EGFR gene mutation.Patients were divided into simple Icotinib group and Icotinib combined with brain radiotherapy group according to their treatment process.Primary objective is to observe the remission of intracranial lesions and progression free survival.Results:1.Intracranial disease objective response rate(ORR)in Icotinib group and combination group were 51.9%(27/52)and 72.7%(48/66)respectely,the difference was statistically significant(?~2=4.57,P=0.03);intracranial disease control rate(DCR)were 86.5%(45/52)and 90.9%(60/66)respectively,no statistical difference was found between two group(?~2=0.21,P=0.65).The intracranial progression free survival(IPFS)of two groups was 8.4 months(95%CI:7.3~9.6)and9.4 months(95%CI:8.2~10.6),the difference was not statistically significant(P=0.18).2.ORR of 19 exon mutation in Icotinib group and combination group were36.4%(8/22)and 71.4%(25/35)respectively,the difference was statistically significant(?~2=5.45,P=0.02).DCR of 19 exon mutation in two groups were 91%(20/22)?85.7%(30/35),the difference was not statistically significant.(?~2=0.34,P=0.56).ORR and DCR of 21 exon mutation in two groups were 63%(17/27)vs.75%(21/28)and81.5%(22/27)vs.96.4%(27/28),the difference was not statistically significant,P value was 0.50,0.07 respectively.The IPFS of 19 exon deletion mutations in the two groups were 8.1 months(95%CI:6.4~9.8)and 9.2 months(95%CI:7.5~10.9),respectively.The difference was not statistically significant,P=0.19.The IPFS of 21exon mutations in the two groups were 8.2 months(95%CI:6.5~9.9)and 9.6months(95%CI:8.1~11.2),respectively,The difference was not statistically significant,P=0.28.3.One year survival rates were 65.4%(34/52)and 59.1%(39/66)in Icotinib group and combination group,the difference was not statistically significant(?~2=0.26,P=0.61).2 year survival rates were 42.3%(22/52)and 39.4%(26/66)in two groups,the difference was not statistically significant(?~2=0.02,P=0.9).There was no difference between two groups in the incidence of side effects such as rash,vomiting,diarrhea,liver damage,bone marrow suppression.Conclusion:1.Icotinib monotherapy or combination of brain radiotherapy as first-line treatment for non-small cell lung cancer with brain metastasis patients who harboring EGFR gene matation can reach a satisfactory effect and the adverse side effects were tolerable.2.ORR of 19 exon mutation in the combined group was higher than Icotinib group,while no difference both DCR and IPFS in two groups.There was no difference in ORR,DCR or IPFS between Icotinib group and combined group.3.For patients with brain metastases those who harboring EGFR mutations,Icotinib combined with brain radiation seems to had better objective response rate when compared with icotinib monotherapy,while the intracranial progression free survival,1 year survival rate and 2 year survival rate had no significant difference. |
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