Again After Chemotherapy Resistance Reversal Targeted Therapy Targeting Treatment Of Advanced Non-small Cell Lung Adenocarcinoma Clinical Observation

Objective: EGFR expression in non-small cell lung adenocarcinoma rate is extremely high, epidermal growth factor receptor tyrosine kinase inhibitors(EGFR TKIs) by inhibiting the activation of EGFR, cut off the pathway of information, inhibits tumor cell DNA synthesis, cell proliferation and tumor metastasis. EGFR- TK, therefore, is an important target molecules, treatment of lung adenocarcinoma with EGFR as targets of targeted therapy is the important treatment of lung cancer, however, EGFR TKIs- acquired drug resistance have hindered the development of targeted drugs, and EGFR- TKIs follow-up after the progress in treatment of advanced NSCLC adenocarcinoma has yet to obtain expert consensus. A retrospective study of this paper is to adopt reverse targeted chemotherapy drug resistance after again using targeted treatment of advanced NSCLC adenocarcinoma(EGFR mutation positive) of clinical efficacy, to explore the diagnosis and treatment of TKI resistance reversal effect of related clinical factors of resistance for TKI treatment after optimizing choice of clinical treatment.Methods: collected in our hospital from May 2011 to December 2013, a total of 40 cases before the treatment received treatment of non-small cell lung adenocarcinoma patients,treatment before the cytological and histological diagnosis of non-small cell lung adenocarcinoma, imaging and pathological diagnosed with locally advanced or transfer stage(Ⅲ b or Ⅳ), genetic testing EGFR mutation positive, ECOG score ≦ 2 points, and at least one lesion can be measured. The 40 patients in TKI acquired drug resistance and disease progression after four cycles of chemotherapy and assesses curative effect, the treatment again after application 250 mg oral treatment, treatment after the first month and then every 2 months for a CT scan to evaluate curative effect.Results: 40 cases of the treatment of initial treatment progress in the median surial progress- free survival(PFS) was 13.21 months and the median overall survival(overall survival, OS) was 10.35 months, the treatment in patients with initial therapy, complete remission(complete response, CR) 0 cases(0%) and partial response(partial response, PR)10 cases(25.0%), stability(stable diseases, SD) 28 cases(70.0%) and progress(progressive diseases, PD) in 2 cases(5.0%). Efficient(response rate, RR) was 25.0%, the disease control rates(diseases control rate, DCR) was 95.0%. After chemotherapy, no CP cases(0%), 4cases(10.0%), PR SD16 cases(40.0%), PD20 cases(50.0%), RR10 %, DCR50 %. The treatment using again after chemotherapy reversal, CR0 cases(0%), PR0 cases(0%), SD17cases(42.5%), PD23 cases(57.5%), RR was 0%, the DCR is 42.5%, the median PFS was2.7 months.Conclusion:1. late-stage NSCLC adenocarcinoma of the treatment(EGFR mutation positive) acquired drug resistance after chemotherapy to reverse some patients can benefit.2. late-stage NSCLC adenocarcinoma of the treatment(EGFR mutation positive) after initial chemotherapy drug resistance reversal the treatment again using some patients can still be of clinical benefit.