Treatment Of Lung Cancer With Small Antiangiogenic Drugs-Analysis Of The Real World

BackgroundApatinib and anlotinib are small molecule tyrosine kinase inhibitors developed by China.Apatinib selectively acts on vascular endothelial growth factor receptor-2 and has not yet been approved for lung cancer.Anlotinib can effectively inhibit vascular endothelial growth factor receptor,platelet-derived growth factor receptor,fibroblasts growth factor receptor and stem cell growth factor c-Kit and other targets,and has been approved in the third-line treatment of NSCLC.This study evaluated the efficacy and safety of apatinib and anlotinib in the treatment of third-line and higher advanced lung cancer.MethodsThe clinical data of patients with advanced lung cancer treated with apatinib or anlotinib in Qilu Hospital of Shandong University from June 2017 to March 2019 were collected.These patients should progress after at least second-line or more treatment.To observe the clinical effect and the occurrence of adverse reactions.The survival curve was drawn by Kaplan-Meier and compared between groups by rank sum test.Main outcome measures:progression-free survival time,secondary indicators:objective remission rate,disease control rate,total survival time,adverse reactions.ResultsUp to March 1,2019,209 patients,138 cases of lung cancer,46 cases of squamous cell carcinoma,15 cases of small cell lung cancer and 10 other cases were followed up.There were 66 patients in apatinib group.The curative effect analysis showed that the objective response rate was 6.06%,the disease control rate was 68.18%,and the median progress-free survival time was 3.00 months(95%confidence interval 2.583<3.417).The median total survival time was 13.00 months(95%confidence interval 9.553≤ 16.447).Multivariate analysis showed that PS score was an independent risk factor for OS[HR=3617,95%CI(1.171,11.168),P≤ 0.02].5].The highest incidence of adverse reactions in the apatinib group were hypertension(36.36%),followed by hand-to-skin syndrome(33.33%)and fatigue(3 1.82%).There were 143 patients in anlotinib group,the objective remission rate was 6.99%,and the disease control rate was 76.92%.The median progression-free survival time was 2.25 months(95%confidence interval 1.853≤ 2.647),and the median total survival time was 11.00 months(95%confidence interval 9.539≤12.461).Cox multiple regression analysis showed that Median disease-free survival time,median total survival time,sex,PS score,age,smoking history,pathological type,gene mutation status and disease stage were not independent factors.The most common adverse event in the anlotinib group is high Blood pressure(24.48%)was followed by fatigue(20.28%)and hand and foot skin syndrome(18.88%).No level 3 adverse events were seen.The drug withdrawal caused by adverse events accounted for 9.09%of the patients with apatinib and 2.80%of the patients with anlotinib.ConclusionsApatinib and anlotinib still have good disease control rate and survival benefit in the treatment of advanced lung cancer,and the adverse reactions can be controlled,which is worthy of clinical application.The PS score during apatinib treatment may be a predictive indicator of therapeutic effect.