Treatment After The Secondary Resistance Caused By Gefitinib In Advanced Or Metastatic In Non-small Cell Lung Cancer

Backgroung and objective:Epidermal growth factor receptor-tyro sine kinase in-hibitors(EGFR-TKI) plays an important role in improving the survival of non-small cell lung cancer(NSCLC).However,the standard treatment after failure of secondary re-sistance caused by Gefitinib which is the first generation of EGFR-TKI is still eagerly needed.This paper is designed to retrospectively study the efficacy and side effects of different treatments after failure of secondary resistance caused by Gefitinib and discuss clinical factors associated with the response to the follow treatment.Methods:Collected from March 2008 to March 2015 in the first affiliated hospital of Dalian Medical University,60 patients cytologically or histologically diagnosed as NSCLC had secondary resistance due to the previously treatment of gefitinib. All of the patients were divided into five groups:12 patients with the treatment of gefitinib plus local treatment(radiotherapy with or without ibandronic transfusion),16 patients with the treat-ment of gefitinib with a higher dose,11 patients with the treatment of chemotherapy alone, 19 patients with the treatment of sequential EGFR-TKI in combination with chemother-apy,2 patients with the treatment of re-administration of another EGFR-TKI(erlo-tinib).Responses were evaluated by Response Evaluation Criteria In Solid Tumors(RE-CIST) version 1.1,and the side effects were classified according to Common Terminology Criteria for Adverse Events (CTCAE)version 4.0.Results:For 60 cases of patients with initial gefitinib treatment,media progression free survival(mPFS) was 40 weeks.As to the follow treatments after secondary re-sistance,mPFS was 27 weeks, ORR was 0,DCR was 58.3%.MPFS for the treatment of gefitinib plus local treatment was 27 weeks, mPFS for the treatment of gefitinib with a higher dose was 20 weeks, mPFS for the treatment of chemotherapy alone was 18 weeks, mPFS for the treatment of sequential EGFR-TKI in combination with chemotherapy was 35 weeks, mPFS for the treatment of re-administration of another EGFR-TKI(erlotinib) was 52 weeks.The initial gefitinib medication timing,PFS length or efficacy of initial ge-fitinib therapy and mutation type of EGFR had no significant influence on PFS of follow treatments.Conclusions: 1.Treatments of gefitinib plus local treatment, gefitinib with a higher dose, chemo-therapy alone, sequential EGFR-TKI in combination with chemotherapy, re-administra-tion of another EGFR-TKI(erlotinib) are all options for the follow treatment after failure of gefitinib,2.Treatment characteristics(initial gefitinib medication timing,PFS length or efficacy of initial gefitinib therapy and mutation type of EGFR) had no significant influence on PFS of follow treatments,3. Treatment of gefitinib with a higher dose or re-administration of another EGFR-TKI is suitable for gradual progression while chemotherapy is for the patient with dra-matic progression. Sequential EGFR-TKI in combination with chemotherapy can be cho-sen according to patient’s ECOG score and tolerance.4.Patients with stable intrapulmonary primary lesions and a local progression can consider the treatment of gefitinib plus local treatment.