The Differences Of Efficacy Of Chemotherapy And Epidermal Growth Factor Receptor-tyrosine Kinase Inhibitor In Advanced Lung Adenocarcinoma Patients Harboring 19del And L858R Mutation

BackgroundAs a common malignant tumor whose morbidity and mortality increasing year by year,lung cancer is the first tumor causes of death.1.5 million people die from lung cancer every year.We have a long way to go for the diagnosis,treatment and prevention of lung cancer.Lung cancer are divided into SCLC and NSCLC by histology and NSCLC include adenocarcinoma,squamous carcimoma,large cell caicimoma and other types.Because the manifestations of early stage lung cancer are poor specificity,65% lung cancer had metastasized when diagnosed,losing the chance to surgery.To the patients who harboring EGFR mutation,chemotherapy and EGFR-TKIs are the main treaments.Here,we mainly discuss the differences of efficacy of chemotherapy and EGFR-TKIs in advanced lung adenocarcinoma patients harboring 19 del and L858 R mutation.Objective1.Investigate the differences of efficacy of chemotherapy and EGFR-TKIs in lung adenocarcinoma harboring 19 del or L858 R mutation respectively.2.To further research the differences of efficacy of chemotherapy and EGFR-TKIs harboring different mutations,dividing the patients by treatments,compare the differences of efficacy treated with the same treatment harboring different mutations.MethodsIn a retrospective study,advanced lung adenocarcinoma patients harboring 19 del or L858 R mutations whose ps score ?2 treated between 2010-10 and 2015-12 in xinqiao hospital are studied.Dividing the patients into 19 del and L858 R by mutation type,compare the efficacy between chemotherapy and EGFR-TKIs for each group;Dividing the patients into chemotherapy and EGFR-TKIs by treatment,compare the efficacy between 19 del and L858 R for each group.Results1.The comparison of different treatments in the same mutation1.1 69 patients of 19 del mutation are included.26 are treated with chemotherapy while 43 are treated with EGFR-TKIs.The baseline of age,sex,smoking history,clinical stage and PS score are consistent.Between the group of chemotherapy and EGFR-TKIs,ORR 30.77% vs 58.14%(p=0.027);DCR 60.38% vs 95.35%(p=0.022),PFS 7.108 months vs 10.652 months(P=0.018),OS 24.387 months vs 27.600 months(p=0.170);1.2 68 patients of L858 R mutation are included.40 are treated with chemotherapy while 28 are treated with EGFR-TKIs.The base line of age,sex,smoking history,clinical stage and PS score are consistent.Between the group of chemotherapy and EGFR-TKIs,ORR 45% vs 17.9%(p=0.020);DCR 95.00% vs 71.4%(p=0.012),PFS 9.901 months vs 6.746 months(P=0.045),OS 21.738 months vs 23.611 months(p=0.378);2.the comparison of different mutations with the same treatment2.1 66 patients treated with chemotherapy are included.26 are 19 del mutation while 40 are L858 R mutation.The base line of age,sex,smoking history,clinical stage and PS score are consistent.Between the group of 19 del and L858 R mutation,ORR 30.77% vs 45.00%(p=0.048);DCR 70.38% vs 95.00%(p=0.023),PFS 7.108 months vs 9.901 months(P=0.020),OS 24.387 months vs 21.738 months(p=0.974);2.2 71 patients treated with EGFR-TKIs are included.43 are 19 del mutation while 28 are L858 R mutation.The base line of age,sex,smoking history,clinical stage and PS score are consistent.Between the group of 19 del and L858 R mutation,ORR 58.14% vs 17.90%(p=0.011);DCR 95.35% vs 71.4%(p=0.022),PFS 10.652 months vs 6.746 months(P=0.022),OS 27.600 months vs 23.611 months(p=0.734);Conclusion1.In 19 del mutation,the ORR,DCR,PFS of EGFR-TKIs treated patients are superior to the chemotherapy.No obvious difference on OS between teams.2.In L858 R mutation,the ORR,DCR,PFS of patients treated with chemotherapy are superior to that with the EGFR-TKIs.No obvious difference on OS between teams.3.To the patients treated with chemotherapy,the ORR,DCR,PFS of patients with L858 R mutation are superior to that with the 19 del mutation.No obvious difference on OS between teams.4.To the patients treated with EGFR-TKIs,the ORR,DCR,PFS of patients with 19 del mutation are superior to that with the L858 R mutation.No obvious difference on OS between teams.5.In the clinical work,we should chose the individualized treatments for lung adenocarcinoma patients according to the type of mutation.