The Clinical Observation Of EGFR-TKI Rechallenge With Antiangiogenic Agents In Advanced NSCLC

Objective:Exploring clinical observation of EGFR-TKI rechallenge with antiangiogenic agents in advanced non-small-cell lung cancer.Methods:Clinical datas of advanced NSCLC patients who received EGFR-TKI rechallenge with antiangiogenic agents in Shanxi Cancer Hospital was collecting from January 2010 to February 2017.Dates were retrospectively analyzed.The efficacy of patients were evaluated according to the RECIST.The clinical characteristics,efficacy and prognosis of 40 cases were analyzed by using the statistical methods.The clinical factors affecting patients' efficacy were analyzed by using Chi-square test and Fisher exact test.Survival analysis was analyzed by using Kaplan-Meier method.Using Log-rank test to analyze single factor.Multivariate factors for prognosis were analyzed by using COX model.Results:1.Clinical features: Patients ages in this study arranged from 42 to 71 years old,the average age was 55 years.This study includes 20 males and 20 females.There are30 patients who were scored 0-1 points according to the ECOG score standard,and 10 cases who were scored ? 2 points.There are 23 non-smokers,and 17 cases who had smoking history.17 cases were clinical stage IIIB phase,23 cases were IV phase.There are 13 patients accepting gefitinib for target therapy,erlotinib 20 cases,and icotinib 7 cases.EGFR gene mutation results: 26 patients exist gene mutation,8 patients were wild-type and the other 6 patients were unknown.There were 23 patients with distant metastasis before treatment,the other 17 patients without distant metastasis before treatment.7patients using EGFR-TKI rechallenge with antiangiogenic agents were treated for second-line treatment,33 for third-line and above treatment.2.Efficacy: There awere 40 advanced non-small-cell lung cancer patients receiving the treatment of EGFR-TKI rechallenge with antiangiogenic agents,There were 0 case achieving CR,9 cases achieving PR,17 achieving SD,14 cases achieving PD according to RECIST standard.The ORR and the DCR were 22.5%(9/40)and 65%(26/40),respectively.The DCR of EGFR gene mutation patients was significantly higher than those in wild-type(P<0.05).3.Prognosis: The median PFS time of 40 advanced NSCLC patients was 6 months,and the MST time was 10 months according to the survival analysis Log-rank test showed that the median PFS was significantly longer in distant metastasis before treatment?stable disease patients?stage IIIB?EGFR mutant and ECOG score 0-1 points than those in no metastasis and progression disease?stage IV?EGFR wild-type?ECOG score ?2 points(P<0.05).The median MST time was significantly longer in patients with EGFR mutation and progression disease?PS?2 points.COX regression analysis showed that presence ofdistant metastases?efficacy?EGFR-mutation?ECOG score were independent factors of PFS;and ECOG were independent factor of MST.4.Adverse events: The most common adverse reactions are rash?anorexia,ect.Conclusion:1.The EGFR-TKI rechallenge with antiangiogenic agents in advanced NSCLC patients is valid and safe.EGFR gene mutation is beneficial factor of the combination in treatment of advanced NSCLC.2.Survival analysis shows that the mPFS: 6 months and MST:10 months.;The presence of distant metastases?EGFR ?efficacy?stage?ECOG score are related with prognosis.COX regression analysis shows that presence of distant metastases,?efficacy?EGFR-mutation?ECOG score are dangerous factors of PFS.ECOG score was independent factor of MST.