A Retrospective Study Of Icotinig Versus Gefitinib In The Treatment Of EGFR-mutated Advanced Non-small Cell Lung Cancer

Objective To compare the efficacy and safety of icotinib and gefitinib in the treatment of EGFR mutant advanced non-small cell lung cancer(NSCLC)and to analyze their prognostic influencing factors to provide new data to support the treatment of patients with advanced NSCLC.MethodsThis study retrospectively collected patients with advanced non-small cell lung cancer diagnosed by pathology or cytology from December 2015 to September 2021 at the First Hospital of the University of Science and Technology of China(Anhui Provincial Hospital).Information on patients’ gender,age,EGFR mutation type,treatment regimen,treatment modality,and cranial metastasis were collected,and the patients were divided into the icotinib and gefitinib groups according to the drugs used,with the observation indexes of progression-free survival(PFS)and secondary observation indexes including objective remission rate(ORR),disease control rate(DCR)and adverse events were observed,and the Cox proportional risk model was used to analyze the prognostic factors.Results1.146 patients were included in this study,including 73 in the icotinib group and 73 in the gefitinib group,with balanced baseline characteristics in both groups.The ORR was38.4% and DCR was 98.6% in the erlotinib group,and the ORR was 39.7% and DCR was 91.7% in the gefitinib group.The difference in the results between the two groups was not statistically significant(P=0.865;P=0.121).In terms of PFS,the median PFS was 14.3 months(95% [confidence interval],CI 11.2-17.4)for patients in the icotinib group and 10.2 months(95% CI 8.6-11.8)for patients in the gefitinib group,a statistically significant difference(P=0.048).A Cox retrospective analysis yielded:EGFR19 exon Del mutation([hazard ratio] HR=0.50,95% CI 0.25-0.998;P=0.049),EGFR21 exon L858 R mutation(HR=0.436,95% CI 0.213-0.889;P=0.022)were prognostic factors for PFS.Subgroup analysis showed that most subgroups of NSCLC patients tended to derive more clinical benefit from icotinib treatment.2.59 and 67 patients received monotherapy with icotinib and gefitinib,respectively.Treatment-related adverse events occurred in 94 patients during treatment,and the adverse reactions in both groups were mainly focused on grade 1-2,including diarrhea,rash,increases transaminase,leukopenia,thrombocytopenia,oral mucositis,and pneumonia.The incidence of adverse reactions was similar between the two groups and was generally well tolerated.Conclusion1.Icotinib had similar ORR and DCR in both groups compared to gefitinib,but significantly improved the PFS of patients.2.Univariate and Cox regression analyses yielded that EGFR19 Del mutation and EGFR21L858 R mutation were factors influencing the good prognosis of patients with PFS.3.Safety analysis showed that the incidence of adverse reactions was similar in both groups,and the overall tolerability was good.