Clinical Efficacy And Prognosis Analysis Of Apatinib Three-line And Above In The Treatment Of Advanced Non-small Cell Lung Cancer

Background and purposeLung cancer poses a huge threat to public health,which is the fastest-growing malignant tumor,and the leading cause of cancer-related deaths worldwide.Non-small cell lung cancer(NSCLC)accounts for 80%and 85%of all patients with lung cancer.Its prevention and treatment is still a serious challenge in today's clinical setting.The early symptoms of NSCLC are usually atypical and difficult to detect,and 75%to 80%of the patients were diagnosed as advanced(?/?).At present,the treatment of lung cancer is based on the principle of multidisciplinary comprehensive treatment,through surgery,chemotherapy and radiotherapy and other comprehensive treatment,the 5-year survival rate is only 15%.Because of the low 5-year survival rate of patients with NSCLC,it has become a hot topic in recent years to explore more effective treatment.The pathogenesis of lung cancer is not clear,and the pathogenesis is complex.the exploration of cell signal pathway,gene expression and tumor angiogenesis in malignant tumors has accelerated the study of molecular targeted therapy for lung cancer.Epidermal growth factor receptor(EGFR)inhibitor is a commonly used targeted therapeutic drug.Targeted therapy is significantly better than chemotherapy for lung cancer patients with EGFR sensitive gene mutation,and the patients have good tolerance with the small side effects.However,patients with negative mutation or drug resistance gene mutation can not benefit from it,so it can not be widely used in clinical practice.Tumor growth requires oxygen supply and nutrients from the body through blood vessels,so inhibiting tumor neovascularization can block tumor growth.Apatinib,as a new antiangiogenic agent,can highly selectively bind to vascular endothelial growth factor receptor-2(VEGFR-2)ATP,and blocking tumor neovascularization.Clinical studies on advanced gastric cancer have shown that Apatinib can prolong the progression-free survival(PFS)of patients,so Apatinib was approved by FDA in October 2014 for third-line or more than third-line treatment of refractory gastric cancer with advanced or metastatic chemotherapy.There are relatively many studies on apatinib in the field of gastric cancer,but relatively few in advanced NSCLC.This study aims to explore the clinical efficacy,adverse reactions and effects of apatinib on serum tumor markers in advanced NSCLC,and discuss the factors affecting prognosis.Meterials and MethodsWe reviewed 66 patients with stage?~?NSCLC confirmed by histology or cytology,who were treated with second-line or above treatment from March 2015 to February 2018.The patients in the observation group were treated with apatinib0.5g/d,while the patients in the control group were treated with docetaxel 75mg/m~2combined gemcitabine 1000mg/m~2regimen every 21 days until the disease progressed or intolerable adverse reactions occurred.The clinical efficacy,the levels of serum tumor markers carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYERA21-1)and adverse reactions were observed before and after treatment.Statistical MethodsThe study used SPSS17.0 software for statistical analysis.Log-rank(Mantel-Cox)test was used for univariate analysis to determine the factors affecting prognosis,and Cox regression model was used to analyze and screen out the independent influencing factors.P<0.05 was considered statistically significant.Results1.Survival analysis:In the observation group,the median PFS was 94 days,the median OS was 176 days,the complete remission(CR)was 0%,partial remission(PR)was 22.9%(8/35),disease stability(SD)was 45.7%(16/35),and disease progression(PD)was 31.4%(11/35),total remission rate(ORR)was 22.9%(8/35)and disease control rate(DCR)was 68.6%(24/35).In the control group,the median PFS was 67 days,the median OS was 150 days,CR accounted for 0%,PR accounted for16.1%(5/31),SD accounted for 22.6%(7/31),PD accounted for 61.3%(19/31),and ORR was 16.1%(5/31),DCR was 38.7%(12/31).2.tumor markers level:There was no significant difference in the levels of CEA and CYERA21-1 between the two groups before treatment(P>0 05).The levels of CEA and CYERA21-1 in the observation group were lower than those in the control group after treatment,the difference was statistically significant(P<0 05).3.Adverse reactions:The main adverse reactions in the observation group were hypertension(40.0%),proteinuria(14.3%),hand and foot syndrome(37.2%),bone marrow suppression(11.5%),digestive tract reaction(25.7%)and liver injury(5.7%).The main adverse reactions in the control group were hypertension(9.7%),proteinuria(6.5%)and hand-foot syndrome(12.9%),bone marrow suppression(74.2%),digestive tract reaction(45.2%),liver injury(9.7%).All of them can be alleviated after symptomatic treatment.4.Univariate analysis:ECOG score and pathological stage were correlated with PFS,ECOG score was correlated with OS.The patients with ECOG score 0?1 have a better prognosis,but sex,age and pathological type were not related to the prognosis.5.Multivariate analysis:ECOG score was an independent influencing factor of apatinib in the treatment of advanced NSCLC.ConclusionApatinib three-line and above for patients with advanced NSCLC,has a certain clinical effect,can reduce the levels of serum tumor markers CEA and CYERA21-1with a high level safety.Patients with good physical condition have a better prognosis.