The Clinical Observation Of Therapeutic Regimens For Slow Progression Advanced NSCLC After First-line EGFR-TKI Therapy

Objective: Almost all NSCLC patients who had acceptted the EGFR-TKI treatment,eventually inevitably appear disease progression. And how to choose a better follow-up treatment of patients who have recived asymptomatic slow progression has become a serious problem. This study aims to compare the short-term efficacy and adverse reactions of three methods in treatment of primary EGFR-TKI treatment, chemotherapy and chemotherapy combined with EGFR-TKI treatment.Method: Selection of Qinghai university hospital and Qinghai provincial people′s hospital in January 2013- December 2015, 56 cases had histological confirmation of advanced NSCLC with an activating EGFR mutation, and disease slow progression after first-line treatment with gefitinib,Were randomly divided into three groups, including 20 cases received primary Gefitinib treatment(Group G), 20 patients accepted single chemotherapy treatment(Group C), 16 cases received chemotherapy combined with Gefitinib treatment(Group CG), 21 days for a cycle. For group G curative effect and adverse reaction were evaluated 1 per cycle.For group C and CG that were to be done at least 2 per cycles.Results:(1)According to the clinical efficacy evaluation :20 cases in Group G, median PFS time was 4 mouths,16 cases(80.0%) reached clinical effective, including 0 cases(0%) of complete remission(CR),1 cases(5.0%) of clinical partial response(PR),15 cases(75.0%) of stable disease(SD);20 cases in Group C, median PFS time was 5 mouths,14 cases(70.0%) reached clinical effective, including 0 cases(0%) of complete remission(CR),4 cases(20.0%) of clinical partial response(PR),10 cases(50.0%) of stable disease(SD);16 cases in Group CG, median PFS time was 4 mouths,11 cases(68.75%) reached clinical effective, including 0 cases(0%) of complete remission(CR),3 cases(18.75%) of clinical partial response(PR),8 cases(50.0%) of stable disease(SD); The differences in the ORR、DCR and median PFS time between different groups had no statistical significance(P>0.05).(2) Adverse reactions: In Group G, there were 14 cases(70.0%) got rash, including 1case of severe rash;3 cases(15.0%) got mild digestive tract reaction,1 case(5.0%) got mild leukocytopenia.In Group C, there were 1 cases(5.0%) got rash,13 cases(65.0%) got digestive tract reaction, including 2 cases of severe symptoms;13 case(65.0%) got leukocytopenia, including 1 case of severe symptoms;1 case(5.0%) got hearing loss.In Group CG, there were 9 cases(56.25%) got rash,11 cases(68.75%) got digestive tract reaction, including 1 case of severe symptoms;13 case(81.25%) got leukocytopenia, including 1 case of severe symptoms.The incidence of leukocytopenia in group G was lower than that in group C and CG(5.0% vs 60.0%,5.0% vs 75.0%), the differences had statistical significance(P<0.001). The incidence of rash in group C was lower than that in group G and CG(5.0% vs 65.0%,5% vs 56.25%), the differences had statistical significance(P<0.001).The differences in the sever adverse reactions between different groups had no statistical significance(P>0.05).Conclusions: 1.There was no difference in short-term efficacy among the patients who have recived asymptomatic slow progression after first-line gefitinib therapy undergoing 3 kinds of secondary treatments including gefitinib therapy, PP/DP chemotherapy alone and PP/DP chemotherapy combined with intermittent gefitinib therapy. 2.As for adverse reactions, the incidence of skin rash reduced in the patients treated with secondary PP/DP chemotherapy alone, and meanwhile the incidence of bone marrow suppression increased in the patients treated with secondary PP/DP chemotherapy combined with intermittent gefitinib therapy. 3.Poor resistance to chemotherapy or senile patients, choose to continue the original TKI treatment, at the same time of clinical may gain a higher quality of life; After TKI resistance to chemotherapy, after the progress again continue TKI therapy is a kind of overcome resistance and attempt to prolong patient survival; The chemotherapy combined with Gefitinib treatment have no clinical benefit, adverse reaction increased obviously, may not suitable for the treatment of advanced patients with drug-resistant; Form the efficacy of economics into consideration, chemotherapy with TKI therapy may not be appropriate choice of resistant patients.non-small cell lung cancer epidermal growth factor receptor...