The Clinical Prognostic Factors And Treatment In Advanced Non-small Cell Lung Cancer

Part Ⅰ:Population characteristics and prognostic factors in metastatic non-small-cell-lung-cancer:A single center retrospectiveBACKGROUND AND PURPOSE:Median survival in metastatic non-small-cell lung cancer is typically less than12months. Over the past decade, platinum-based combination chemotherapy regimens have become the mainstay of treatment of advanced NSCLC, and which can prolong survival, improve symptom control and yield superior quality of life. Moreover, the recent introduction of target therapy for NSCLC has further prolonged survival in selected patients. However, treatment still continues to be given with palliative intent. Despite this, there is a great heterogeneity in these patients. The physical condition of different patients at the time of diagnosis, distribution of lesions, the number of transfer parts and severity are very different, different individual response to treatment choice must also be different, therefore the judgment of the prognostic factors selected for the treatment of cancer patients is significantly important. This study aims to understand the clinical characteristics of our hospital with advanced non-small cell lung cancer, and possible prognostic factors were analyzed.PATIENTS AND METHODS:We searched for patients with treatment-naive stage Ⅳ (metastatic) NSCLC who were first seen at our hospital between January2006and December2006. Patients with other past or concurrent malignancies, those who were seen for a second opinion visit without any follow-up, those who had received chemotherapy before presentation at our hospital, and those who had progressed to metastatic disease from previously documented localized disease were excluded. We retrospectively evaluated the charts of153consecutive, unselected patients aged28-79years (median,58years) with stage Ⅳ NSCLC. Cox proportional models were used to conduct univariate and multivariate analyses of baseline prognostic factors.RESULTS:Median age was62years;74.5%of patients were PS0/1at first presentation. Fifty-six percent had single organ metastasis;29%had brain metastases (one third had a solitary brain metastasis). Bone metastasis accounts for38.6%, vertebrae (26.8%) and ribs (17.6%), and iliac (17.6%)are the most commonparts. The median overall survival (OS) was17.05months (95%CI:13.09-21.01). Univariate analysis showed:female (p=0.00), adrenal metastases<2(p=0.01) and LDH≤210(p=0.00) reached statistical difference, which are good prognosis factors, while adenocarcinoma, brain metastases is <2, the statistical P were0.05, also promise strong prognostic significance. On multivariate analysis,gender(p=0.004),brain metastases (p=0.039)and adrenal metastases(p=0.005) are prognostic factors.CONCLUSION:Univariate analysis of the study showed that gender, adrenal metastasis foci number and pre-treatment plasma LDH levels correlate with the prognosis of advanced non-small cell lung cancer. Pathology is adenocarcinoma, the number of brain metastases also showed the trend of the prognosis. However, because of the small study sample, the prognostic factors in our study were gender, brain metastases and adrenal metastases on multivariate analysis,and expanding the study of the samples may be able to get a more definite conclusion, which has important significance for the guidance of advanced non-small cell lung cancer treatment options. Part Ⅱ:The efficacy of pemetrexed as second-line or beyond therapy in patients with advanced non-small cell lung cancerBackground and objective:Pemetrexed is one of the standard second-line therapies in advanced non-small cell lung cancer (NSCLC). Currently, there is no standard cytotoxic treatment beyond second-line therapy. We evaluated the efficacy and safety of pemetrexed as a salvage regimen in heavily pretreated NSCLC patients.Methods:Clinical data of thirty-seven patients with advanced NSCLC who received pemetrexed as second-line or beyond therapy were reviewed and analyzed retrospectively.Results:Thirteen patients (35.1%) received pemetrexed as second-line treatment, twenty-four patients (64.9%) received pemetrexed as third-line or beyond treatment. One patient achieved CR (2.7%), two patients PR (5.4%), seventeen patients SD(45.9%) and twelve patients PD(32.4%), with a disease control rate of54.1%. The median progression-free survival (PFS) was8.05months, and the median overall survival(OS) was19.29months.Conclusion:Pemetrexed as second-line and beyond therapy for advanced NSCLC result in favorable efficacy and tolerable toxicity, and should be a rational recommendation. Part III:Clinical response to gefitinib re-treatment in lung adenocarcinoma patients who benefited from the initial gefitinib therapy:a retrospective analysisBackground:Gefitinib is an EGFR tyrosine kinase inhibitor and has been widely used in the treatment of non-small cell lung-cancer (NSCLC).Gefitinib is mostly effective in women, patients who have never smoked, patients with pulmonary adenocarcinomas, and patients of Asian origin. Several treatment options are available for NSCLC patients who responded to initial gefitinib therapy but demonstrated tumor progression, of which re-administration of gefitinib is the option of choice. The aim of this study is to evaluate efficacy and toxicity of gefitinib re-challenge.Methods:Clinical data of18patients with NSCLC adenocarcinoma who had achieved partial response (PR) or stable disease (SD) after administration of gefitinib and were re-treated with gefitinib due to failure of the initial gefitinib therapy were reviewed and analyzed retrospectively.Results:Of the18patients who suffered from NSCLC adenocarcinoma and received gefitinib therapy as the2nd EGFR-TKI, one patient (6%) achieved partial remission (PR),11patients (61%) achieved SD, and6patients (33%) experienced disease progression. The disease control rate was67%, and the median progression-free survival was5.16months (range1-24.8months). The median overall survival from the initiation of gefitinib therapy was39.4months (range15.38-52.44months). The median overall survival from the beginning of the2nd gefitinib therapy was12.41months (range3.98-38.24months). There was mild toxicity associated with the2nd gefitinib therapy.Conclusions:Our results indicate that patients with NSCLC adenocarcinoma may still be expected to have prolonged survival by giving re-administration of gefitinib if they once responded to gefitinib and underwent various subsequent treatments.