Curative Effect Analysis Of Gefitinib Versus Chemotherapy As The First-line Treatment For The Patient With Advanced Non-squamous Non-small Cell Lung Cancer

Object:By observing the clinical efficacy of gefitinib and platinum double-drug chemotherapy regimen as the first-line treatment in patients with advanced non-squamous non-small cell lung(NSCLC),we evaluated the progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR)and adverse reactions of patients with advanced non-squamous non-small cell lung admitted in our hospital in recent years.And we evaluated the clinical efficacy of gefitinib in subgroup patients with 19 exon deletion and 21 exon L858 R mutation.in order to provide more scientific and useful diagnosis and treatment for advanced NSCLC patients,prolong survival and improve the quality of life.Method:All patients were hospitalized in the first hospital of lanzhou university,and they were confirmed as advanced non-squamous non-small cell lung cancer by pathology.From June 2012 to December 2016,a total of 50 patients were treated with geitinib.All patients were presented with epidermal growth factor receptor(EGFR)mutation(mainly 19 exon deletion or 21 exon L858 R mutation).For these patients with EGFR mutation positive,gefitinib was given as a first-line threatment.A total of 50 patients were enrolled in the chemotherapy group from June 2013 to December 2016.The patients in this group were not selected,and their EGFR mutation was unknown.All patients were treated with platinum plus third-generation cytotoxic drugs(docetaxel,paclitaxel or gemcitabine)for antitumor therapy.During the treatment,two groups of patients regularly reviewed imaging and blood biochemical examination,and evaluated the short-term efficacy(ORR,DCR),PFS and adverse reactions.Results:In the targeted group,CR0,PR27(54%),SD17(34%),and PD6(12%),ORR 54%,DCR 88%.The median progression-free survival(PFS)was 8.2 months(95%CI: 8.0-10.7).in the subgroup,compared with 19 exon deletion group,although L858 R mutation patients had longer median PFS(8.7 months VS 8.2 months)and higher ORR(60% vs 51.7%),the statistical difference was not significant(P>0.05).All patients had a mild response to gefitinib,with rashes(28%)and diarrhea(24%),mainly 1-2(88.4%),and most patients were well tolerated with symptomatic treatment.In the chemotherapy grop,CR0,PR15(30%),SD20(40%),and PD15(30%),ORR 30%,DCR 70%.The median PFS was 5.0 months(95%CI: 4.86-6.42).The most common adverse reactions were gastrointestinal irritation(74%)and myelosuppression(54%),Nausea and vomiting and myelosuppressionat level 3 or above accounted for 21.6% and 29.6%,respectively.In the study,2 cases were terminated or switched to other programmes due to severe leukopenia.Conclusion:At present,molecular targeted therapy and chemotherapy are the most common treatment modality in advanced NSCLC patients,both of which can effectively inhibit tumor growth,control disease progression and prolong survival.But compared with platinum-based chemotherapy regimen,Patients treated with gefitinib had significant clinical advantages in both the PFS?ORR and DCR,and this curative effect is similar in 19 exon deletion and L858 R mutant patients.Gefitinib has less adverse reactions and light side effects,and most patients can tolerate it well.