The Third-line Chemotherapy For The Treatment Of Advanced Non-small Cell Lung Cancer-a Single Institute Retrospective Study

Object：The substantial benefit and risk of third-line chemotherapy in advancednon-small cell lung cancer (NSCLC) patients is still unclear. We retrospectivelyevaluated the efficacy and toxicity of third-line chemotherapy in advanced NSCLCpatients and assess the factors that might influence efficacy and survival in third-linechemotherapy.Methods： Fifty two advanced NSCLC patients received a third-linechemotherapy after failure of second-line chemotherapy. Pemetrexed taxanes andirinotecan were major adopted drugs. Logistic classification regression is used toanalysis the factors which may influence the efficacy of the third-line chemotherapy.Survival analysis was conducted based on Kaplan–Meier method; the log-rank testwas used to compare PFS and OS between clinicopathologic characteristics. Coxmultivariate analyses were performed to define the prognostic significances of OS.Results：In52cases of advanced NSCLC patients with third-line chemotherapy,ORR and DCR is5.7%and34.6%respectively; PFS and OS is the2.30month and4.51months respectively. Logistic regression analysis showed that PS score andthird-line chemotherapy regimens influenced efficacy of third-line NSCLC chemoth-erapy. Cox proportional hazards model display third-line chemotherapy efficacy is theonly one independent prognostic factor.Cancer-related symptom relief improvementwas confirmed in48.8%patients (22/45). Two cases with poor PS score oftreatment-related death occurred due to febrile neutropenia. Totally thirty patientsappeared Grade III-IV toxicity.Most frequent grade3to4toxicity included myelos-uppression(50%). Patients treated with doublet chemotherapy had significa-ntly moregrade3to4toxicity.Patients of aged65years or older, poor PS score and onceoccurring grade3to4myelosuppression during the first-or secondline chemotherapywere more likely to have grade3to4myelosuppression.Conclusions：Patients with advanced NSCLC could get benefits from third-linetreatments, as reliving cancer-related symptoms, controlling disease progression,withtolerable toxicity. Doublet chemotherapy as third-line treatment of advanced NSCLC with good PSscore significantly increases response rate, progression-free survival and overallsurvival, compared to single-agent.For those older, poor PS score and once occurring grade3to4toxicity duringthe first-or second-line chemotherapy patients, third-line chemotherapy should beadministrated cautiously, especially doublet chemotherapy.