Comparison Of Clinical Characteristics And The Effect Of Gefitinib With Advanced Lung Adenocarcinoma Patients Harbouring EGFR Mutations In Exon 19 And 21

Purpose:For the treatment of advanced lung adenocarcinoma,the effect of EGFR-TKI on different EGFR mutations is different,and themutations of EGFR Exon19 deletion mutation and Exon21 L858 R mutation were most common in the mutant.The purpose of this study was to discuss the correlation between the clinical features of EGFR Exon19 deletion mutation group and Exon21 L858 R mutation group,and observe the first application of epidermal growth factor receptor tyrosine kinase inhibitors(Epidermal growth factor receptor after the diagnosis of tyrosine kinase inhibitor,EGFR-TKI)objective remission rate(Objective Response,Rate,ORR),disease control rate(Disease Control,Rate,DCR)and progression free survival(Progression Free,Survival,PFS),to evaluate the different of the curative effect between them.Methods: Collected from January 2011 to January 2017 treated inthe Affiliated Hospital of Qinghai University,Qinghai Red Cross Hospital and from Qinghai People's Hospital,and EGFR gene was detected as Exon19 deletion mutation or Exon21L858 R mutation positive,IV phase of lung adenocarcinomaexcept for brain metastasis,and patients taking first-line oral gefitinib for molecular targeted therapy.Exon19 deletion mutation group 29 cases,Exon21 L858 R mutation group of31 cases.The clinical features such as gender,age,smoking history,clinical stage,Group(Eastern Cooperative Oncology,ECOG)score and family history of cancer were collected.The correlation between the clinical features of the two groups was analyzed,and the differences of the therapeutic effect between the two groups were compared.Results:(1)Clinical evaluation of Exon19 deletion mutation group 29 cases,the complete remission(Complete Remission,CR)in 0 cases(0)%,partial remission(Partial Remission,PR)in 17 cases(58.6%),stable(Stable Disease,SD)in 12 cases(41.4%),disease progression(Progression of Disease,PD)0 cases(0%),ORR was58.6%,DCR was 100%,the median progression free survival(Progression Free,Survival,PFS)for 10.4 months;Exon21 mutation in L858 R group of 31 cases,including 0 cases of CR(0)%,13 cases of PR(41.9%),16 cases of SD(51.6%),PD 2cases(6.5%),ORR was 41.9%,DCR was 93.5%,the median PFS was 9.1 months.The results showed that Exon19 deletion mutation group and Exon21 L858 R mutation group in ORR(P=0.192),DCR(P=0.492)and PFS(P=0.065),the former was better than the latter,but the difference was not statistically significant.(2)Single factor analysis was used to analyze the clinical characteristics of the 60 patients.The results showed that gender,age,smoking history,clinical stage,ECOG score and family history had no significant effect on PFS.(3)By multivariate analysis further analyzed the influence of the clinical features of the two groups of patients with PFS.The results show that in all clinical features,Exon19 deletion mutation PFS L858 R mutation group were lower than Exon21 group,but only in the female group(P=0.004),60 years of age or older group(P=0.002)and no smoking group(P=0.001),the ECOG score is more than 2 packet(P=0.028)with statistical significance,and in the male group,age < 60 years old group,smoking group,ECOG score of 0-1 group and whether there is a family history of cancer in the group was not statistically significant.Conclusion:(1)There was no significant difference in PFS,PFS,age,smoking history,ECOG score and family history of EGFR in patients with advanced L858 R and Exon21 in patients with locally advanced and advanced lung adenocarcinoma;(2)The short-term efficacy of EGFR gene deletion mutation in patients with Exon19 may be better than that in patients with Exon21 L858 R mutation(3)EGFR gene deletion mutation of Exon19 in patients with PFS or L858 R mutations were longer than Exon21,in female,60 years of age or older,non smoking,ECOG score was statistically significant more than 2 packets,while in men,age < 60 years,smoking,ECOG score 0-1 points and whether there is a history of tumor group was not statistically significant;(4)Exon19 gene deletion mutation of EGFR gene can be used as a predictive factor for targeted therapy.