Clinical Curative Effect Study Of First-Line And Second-Line Treatment By Gefitinib For Patients With Non-Small-Cell Lung Cancer

Objective:The most ordinary pathological therioma with the highest morbidity and mortality is lung cancer currently. Non-small cell lung cancer takes up 80%~85%.For the past few years, EGFR-TKIs,the typical case is gefitinib, has showed remarkable clinical curative effect in the remedy of non-small cell lung cancer. This essay was a retrospective analysis which based on curative effect and survival datas of 49 patients with non-small cell lung cancer from The FIrst Affiliated Hospital,Da Lian Medicine University. Their EGFR mutation status is treatment of patients with non-small cell lung cancer(NSCLC) known and belong to the sensitive type,all of that were treated with gefitinib as first-line or second-line therapy.We should explore the optimal timing to use EGFR-TKI,and Analyzing the advantages and disadvantages between the first-line and second-line treatment of in non-small cell lung cancer(NSCLC).Methods:Co llect the specimens of 121 cases of patients with lung adenocarcinoma Tumors,from the second affiliated hospital of Dalian medical university between2011.10 to 2014.9,then we have the genetic sequencing of the specimens. These cases could add into the team which must meet the following conditions :according to the histology and cytology diagnosis who were identified as non-small cell lung cancer,and EGFR gene mutation test is positive,and is sensitive to EGFR- TKI treatment,stage of TNM for Ill B or Ⅳ,as the RECIST standard, the tumor can be measured,the expect survival time are at least three months,the treatments were maked by gefitinib in the first-line or sececond-line treatment, follow-up is convenient to complete.And we would to exclude the following situations such as the treatment include other systemic anti-tumor treatment at the same time; there are other malignant tumors,;surgical wound has not healed,;pregnancy or lactation; interstitial lung disease.Then we select 38 patiants in the group, who must make the imaging examination on a regular basis, to estimate therapeutic effect as Evaluation standard of Solid tumor(Response Evaluation Criteria in Solid Tumors, RECIST) 1.1, and take follow-up for understanding the m PFS. In the group,there are 15 people for male, 23 people for female; 5 and 33 people respectively belong to Ⅲ b and Ⅳ for the tumor;there were 13 peoples who less than or equal to 65- year- old, and other 25 peoples whose ages had beyond more than 65- year- old patients;28 patients are without or mild smoking, 10 patients has smoking history;18 patients with the treatment used the first-line treatment, 20 patients with the treatment used the second-line therapy. To decide the survival curves using “Statistical Package for the Social Sciences 19.0”statistical software and survival rates analysis would be maked by Kaplan-Meier analysis, between the two groups, compared with the SPSS 19.0 statistical software, if the P valueis less than 0.05,we kan consider that there are not significant differences.Results:In the group,the gender(P =0.714)and the s moking(P =0.468) and the age(P =0.087)and the disease stage(P = 0.653) had not significant statistical differences,these general characteristics had not any effects for the c omparison bet ween first-line and second-line treat ment. The 38 cases in the group: CR 0 cases, PR 20 cases, SD 9 cases, PD 9 cases, the response rate RRis52.6 %, the DCR is 76.3 %;in the 18 cases who accept the first-line che motherapy treat ment: CR 0 cases, PR 13 cases, SD 4cases,PD 1 cases, RR is 72 %, DCRis 94.4 %. In the 20 cases who accept the second-line treat ment: CR 0cases, PR 7 cases, SD 5 cases, PD 8 cases,RR is 35 %, DCR is 60.0 %. In the 29 cases who had control the t umor: t he the PFS of first-line is 23 weeks; in second-line treatment group:PFS is20 weeks.For the different treatment methods,the P value are all more than 0.05.Conclusion Basic clinical characteristics such as gender, smoking history, age, disease stage and so on of patients who had non-small cell lung cancer,have not statistically significant differences in the treatment with first-line and second-line.Though, for the patients who with EGFR mutations and suitable for EGFR-tki,the treatment for first-line and second-line treatments are useful to inverstigate. Obviously first-line intreatment increase the short-term curative effect, but there is not statistical differences which is found between the effects of survival time for the Long-term benefits.The fiist-line treatment of gefitinib to the patients with lung adenocarcinoma Tumors, clinical benefit rate is higher, and have better effective so the utilization rate of second-line higher recently, but the long-term curative effect has not obvious differences in these treatments.Combined with chemotherapy and molecular targeted drug toxicity comparison, molecular targeted drugs, side effects is lighter, especially the patients who are sensitive to EGFR- TKI and chemotherapy resistance in non-small cell lung cancer patients with first-line treatment should be the first to use molecular targeted drugs;More large samples are needed to the randomized controlled study of the relationships between the factors which can make the detection of EGFR mutation rapidly, accurate, economic. Then wo need a new method that can detect EGFR mutations, because the specimens from biopsy is difficult to obtaine,and the pretreatment of specimens is complex, we must find a better detection object to replace them in the future.