Clinical Study Of Adding Dose Of Icotinib In The Treatment Of Advanced Lung Adenocarcinoma

BackgroundAs far as we all know,the mutation of EGFR gene is very important in patients with advanced lung adenocarcinoma.About 10%~44%of the patients have the mutation of EGFR gene,which is the driving factor of primary lung cancer,and more of them occur mainly in women.In Asians and non-smokers,Icotinib is a tyrosine kinase inhibitor,TKIs.With the development of technology and gene technology,it has been developed and applied to clinical.EGFR mutation significance lies in the targeted treatment of lung adenocarcinoma patients.In the years leading up to the large randomized controlled trial,RCTs confirmed the superiority of target drugs.It has been shown that EGFR gene mutations are more effective in sensitized patients than in conventional chemotherapy.Gene detection of EGFR mutations and anaplastic lymphoma kinases(ALKs).Molecular selection gene rearrangement is now an advanced standard for the treatment of advanced lung cancer.In addition,the molecular characteristics of non-small cell lung cancer(NSCLC)are becoming more and more popular.However,NSCLC without allergy EGFR mutation needs to continue empirical chemotherapy on the basis of traditional treatment.But with the long-term application of targeted drug Icotinib,Patients with gene EGFR mutationswill inevitably develop in the end.In order to investigate the clinical efficacy and safety of adding dose of Icotinib after targeted therapy,we selected 88 patients who were treated in our hospital from January 2015 to January 2017 for TNM stage.For stage IV lung adenocarcinoma patients,The clinical efficacy and safety after treatment were analyzed retrospectively.ObjectiveA total of 88 patients with stage IV lung adenocarcinoma who had failed in routine dose of Icotinib were enrolled in this study.The short-term and progression free survival time and overall survival time and adverse reactions during treatment were observed and recorded.To compare the efficacy and safety of pemetrexide plus cisplatin in the treatment of advanced lung adenocarcinoma.MethodsPatients with follow-up records from January 1st 2015 to January 1st 2017 in the first affiliated Hospital of Zhengzhou University were selected as study subjects.Patients with stage IV lung adenocarcinoma with TNM staging were selected as study subjects.The clinical data of 88 patients with advanced EGFR mutation of exon 19 or exon 21 were confirmed by cytology or histopathology.In the adding dose of Icotinib group,125-250 mg Icotinib tablets were given orally for three times per day until the disease progressed or an intolerable adverse reaction occurred.Then the best treatment was given.Chemotherapy group:pemetrexide(500mg/ivgtt q21d d1)and platinum for 4-6 cycles.Ct or MRI were reexamined once every two months to observe the tumor focus.Methods the patients were evaluated by referring to the criteria for evaluating the curative effect of solid tumors(RECIST 1.1).The results of the study were statistically analyzed by SPSS21.0 software.χ~2 test was used for counting data,and Kaplan-Meier method was used to draw survival curve by Fisher exact test.The difference between subgroups was further compared by Log-rank test(χ~2=4.598,P=0.032)。ResultsIn the adding dose of Icotinib group,there were 0 cases of CR and 23 cases of SD and 16 cases of PD.The ORR was 11.4%and DCR was 63.6%,and that of pemetrexide group was 0 cases of CR,12 cases of PR and 22 cases of SD,10 cases of PD.The ORR was 27.3%and DCR was 77.3%.There was no significant difference in the control rate and the objective effective rate between the two groups in the control rate and the objective effective rate of the disease in the short term.The median PFS and OS were 3.5 months and 10.2 months in the adding dose of Icotinib group.The median PFS and OS in pemetrexide chemotherapy group were 3.2 months and 9.9months respectively.The K-M trapezoid of median PFS(χ~2=0.72,P=0.396)and median OS(χ~2=0.457,P=0.499)in the two groups were examined by Log-rank.Compared with pemetrexide chemotherapy group,there was no significant difference between the two groups.There was no significant difference in both short-term and long-term effects.Referring to CTCAEV4.0,adding dose of Icotinib group had grade3 or more adverse effects.There were 8 cases of severe rash.In the pemetrexide chemotherapy group,23 cases of bone marrow suppression above III degree.The incidence of severe adverse reactions in adding dose of Icotinib group was significantly lower than that in pemetrexed chemotherapy group(χ~2=4.598,P=0.032)。Conclusions1.There was no significant difference in the short-term efficacy and the total survival and progression free survival of time adding dose of Icotinib and pemetrexide combined with platinum chemotherapy in patients with EGFR mutation in advanced lung adenocarcinoma,but the incidence of severe adverse reactions was significantly lower.2.For patients with EGFR mutation in advanced lung adenocarcinoma has failed in first-line therapy of Icotinib,the dosage of Icotinib is expected to continue as a second-line drug.