| Purpose： Lung cancer is the most common malignancy in the world.Clinical validation broadly classified into small cell lung cancer (SCLC)and non-small cell lung cancer (NSCLC). NSCLC including large cellcarcinoma, squamous cell carcinoma and Aden carcinoma (includingbronchoalveolar larvae cancer).70%-80%of patients in non-small cell lungcancers were found in the middle and late period lost the chance ofoperation. First-line chemotherapy for advanced non-small cell lung cancer,platinum drugs was based on dual-drug program based efficiency between25%-35%, progression free survival time (PFS) was4-6months, mediansurvival period was8-10months, similar to the efficacy of the programs.Continue maintenance therapy compared with best supportive care prolongdisease progression and survival of a number of large-scale clinical studieshave shown that the first-line chemotherapy diseases are controlled. Thesecond-line standard regimen of docetaxel or penetrated single-agentchemotherapy and gefitinib or erlotinib targeted therapy. Maintenancetherapy reduced the second-line treatment efficacy, adverse reactionsaggravated second-line treatment. In this experiment, through the analysisof the prognosis of advanced NSCLC second-line therapy and side effects ofmaintenance treatment, how to choose effective treatment, suitable foradvanced NSCLC,and provide clinical evidence.Methods: Our hospital August,2005to2012were histological orcytological confirmed and clinical stage the Ills Phase-IV of NSCLC cases,75cases, including44males and31females; with an average age of60.49years;31people had a habit of smoking, no smoking of44;9squamous cellcarcinoma,66adeno carcinoma, including EGFR mutations in4patients, patients with KRAS mutations1, EGFR negative patients; TNM stage10cases of stage IIIB, IV of65cases; before the first-line treatment ECOGscore0-1has60people, score2has15; first-line treatment after theefficacy of PR24, SD51.36patients with advanced NSCLC after first-linechemotherapy standard maintenance therapy until disease progression,given the standard second-line treatment regimen, enrolled in theexperimental group;39patients with advanced NSCLC after first-linechemotherapy to best supportive care, the standard second-line treatmentregimen given after disease progression, enrolled in the control group.Chemotherapy patients are21days for one cycle of chemotherapy, and allpatients every two cycles of measurable tumor lesions checks. Targetedtherapy in patients with medication a month and after every2months tocheck the measurable tumor lesions. Test in accordance with the NCIentities the Tumors evaluation (RECIST) criteria to evaluate the efficacyand Statistics patients with objective response rate (ORR), disease controlrate (DCR), progression-free survival (PFS) and overall survival (OS).Results:1) In75patients, two groups ORR difference was notstatistically significant (P=0.773); DCR maintained the treatment ofsecond-line treatment33.34%,58.97%less than best supportive care aftersecond-line treatment, the difference was statistically significant (P=0.026). Subgroup analysis of maintenance therapy after second-linetreatment option for targeted treatment of cases contrast chemotherapy vs.chemotherapy, ORR and DCR was no significant difference (P=0.750, P=0.683); best supportive care after second-line treatment options for targetedtreatment of cases, The ORR and DCR differences were not statisticallysignificant (P=0.692, P=0.765).2) test group of second-line treatmentmedian PFS of5.33months, the control group second-line treatment medianPFS was5.74months, the difference was not statistically significantdifference (P=0.644). The test group median OS was24.31months in thecontrol group median OS was20.81months, and between the two there is astatistically significant difference (P=0.036). Subgroup analysis ofmaintenance therapy after second-line treatment option for targeted therapycases median PFS was5.50months, median OS was24.53months; undergoing chemotherapy median PFS was5.25months, median OS was23.76months, the difference was not statistically significance (P=0.543, P=0.434). Best supportive care after second-line treatment option fortargeted therapy cases median PFS was6.88months, median OS was23.71months; undergoing chemotherapy median PFS was5.13months, medianOS was19.20months, between no significant difference (P=0.119, P=0.213). Between the two groups targeted treatment of cases of PFS and OSwere not statistically different (P=0.416, P=0.519)(Table9). Between thetwo groups of chemotherapy cases PFS was no significant difference (P=0.971), higher than best supportive care after second-line treatment of casesOS to maintain a second-line treatment of cases after treatment OS, astatistically significant difference (P=0.016).3) second-line treatmentoption for targeted therapy cases of major toxicities were rash and diarrhea,undergoing chemotherapy toxicity for nausea and vomiting, and bonemarrow suppression, were compared between the test and control groupstargeted therapy and chemotherapy cases, adverse reactions quite, nosignificant difference.Conclusions:1) the efficacy of second-line treatment in advancedNSCLC maintenance therapy after second-line therapy with best supportivecare.2) Maintenance treatment of advanced NSCLC, second-line treatmenttoxicity incidence is not higher than the best support for second-linetreatment after treatment toxicity incidence of patients can be tolerated.3)Result in a prolonged overall survival after first-line chemotherapy foradvanced NSCLC would be maintained. |
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