Analysis Of True Diagnosis And Treatment Of 40 Cases Of Advanced Biliary Tract Cancer With Jiawei Wumei Pills Combined With Afatinib

1 research background Biliary tract cancer is a highly heterogeneous tumor produced by intrahepatic ducts,extrahepatic bile ducts,and gallbladder epithelial cells.Its incidence is low,accounting for 0.7% of all malignant tumors in adults.In recent years,its incidence has increased worldwide..There is currently no effective treatment for biliary tract cancer,and the only cure is radical resection.However,due to the atypical clinical symptoms,the vast majority of patients(>65%)had a local tumor infiltration or lymph node or distant metastasis at the initial definitive diagnosis,and lost the opportunity for surgical resection.The treatment of advanced biliary tract cancer includes radiotherapy and chemotherapy,intervention and support for symptomatic treatment,but the efficacy is not good.In recent years,there has been a shift towards molecular-based,personalized cancer treatment models,such as erlotinib,trastuzumab,and cetuximab,which are approved for lung cancer,breast cancer,and Colon cancer.Genetic studies of biliary tumors have also revealed growth factors and receptors as well as downstream signaling pathways that control the growth and survival of biliary epithelial cells.Target-specific monoclonal antibodies and small molecule inhibitors that act on signaling pathways that drive the growth and invasion of biliary tract cancer have also been in research and development and clinical trials.Afatinib is a potent,irreversible dual inhibitor of the epidermal growth factor receptor EGFR and human epidermal growth factor receptor 2(HER-2)tyrosine kinase.It binds covalently to the kinase regions of EGFR(Erb B1),HER2(Erb B2)and HER4(Erb B4),irreversibly inhibits autophosphorylation of tyrosine kinases,resulting in down-regulation of Erb B signaling,blocking EGFR,HER2-mediated tumor cells Conduction inhibits the proliferation and metastasis of tumor cells and promotes apoptosis of tumor cells.Studies have shown that EGFR and HER-2 are overexpressed in biliary tract cancer,which can be used as a theoretical basis for the treatment of biliary tract cancer with afatinib.At present,there is no clinical research and literature report on the use of afatinib in patients with biliary tract cancer.The purpose of this study was to investigate the efficacy and safety of Jiawei Wumei Pill combined with afatinib in patients with biliary tract cancer.2 Research purposes Follow-up and collect the patients with advanced biliary tract cancer admitted to the Department of Oncology and Oncology,Anhui Provincial Hospital and Anhui Medical University,and collect relevant data,objectively evaluate the involvement of Jiawei Wumei Pills and afatinib maleate.The efficacy and safety of patients with advanced biliary tract cancer(stage IIIB-IV)provide evidence-based medical evidence for the diagnosis and treatment of patients with advanced biliary tract cancer.3 research methods The patients with advanced biliary tract cancer who were admitted to the Department of Oncology and Oncology,Anhui Provincial Hospital and the Department of Integrative Medicine,Anhui Medical University,from January 2017 to April 2019,collected relevant data from patients,according to the exclusion criteria,and finally included Forty patients were analyzed and the effects of Jiawei Wumei Pills combined with afatinib maleate on patients with advanced biliary tract cancer were evaluated by data analysis.The main indicators included TCM symptom efficacy,safety,quality of life,and overall survival exceeded.Twenty patients who survived at 6 months or at the end of follow-up were retrospectively analyzed.4 research results 1 Clinical benefit: The clinical benefit rate(CBR)of the whole group was 65%(26/40),of which 16 cases(40%)showed decreased dose of pain-relieving drugs or decreased pain,and 15 cases(37.5%)of physical condition after treatment.The index increased by more than 20 points,and the weight gain increased by 7% or more in 10 cases(25%).2 Quality of life: The quality of life improvement rate was 37.5% and the quality of life stability rate was 52.5% after 1 period of treatment with Wumei Pills combined with afatinib.3 TCM symptom improvement rate: 7 patients with Chinese medicine intervention less than 1 month,Chinese medicine symptom improvement rate 57.1%,18 patients intervening for 1-6 months,TCM symptom improvement rate 72.2%,intervention for 6 months or more 15 people,Chinese medicine The symptom improvement rate was 80.0%.4 Safety: 40 patients with low incidence of targeted therapy adverse reactions,no grade IV adverse reactions(myelosuppression,diarrhea,rash)safety,no treatment-related death.5 Toxic reaction: Toxic reactions can be evaluated in 40 patients.Common toxic reactions are myelosuppression,diarrhea and rash;bone marrow suppression is characterized by leukopenia and thrombocytopenia,and no IV white blood cell and thrombocytopenia.There were more patients with rash,diarrhea and oral mucositis in the whole group,but they were not heavy,all of them were I--II degree,and they were able to tolerate continued treatment without serious adverse events.6 Survival: 14 patients with a total survival of more than 6 months,5 of whom survived the follow-up,26 patients with a total survival of less than 6 months,6 of whom survived the end of follow-up.5 Research conclusions 1 Jiawei Wumei Pills combined with afatinib in the treatment of advanced biliary tract cancer can improve the clinical symptoms,improve the quality of life,reduce the side effects of targeted drugs,is an alternative treatment.2 Jiawei Wumei Wanfang combined with afatinib-based treatment provides more treatment options for patients with advanced biliary tract cancer,and has certain clinical application value.3 Jiawei Wumei Pills combined with afatinib to participate in the comprehensive treatment,benefit most patients with biliary tract cancer,is the trend of treatment of patients with advanced biliary tract cancer.