Patterns Of Care And Its Efficacy Analyses In Patients With Advanced Non-squamous Non-small Cell Lung Cancer

Objective: Non-squamous non-small cell lung cancer has the characteristics of high mutation rate and diversified treatment mode.The purpose of this study is to explore the influence of clinical characteristics,genes,treatment modes and other factors on the prognosis of advanced non-squamous non-small cell lung cancer patients.Methods: Retrospectively analyzed the clinical data of 480 patients with advanced non-squamous non-small cell lung cancer admitted to the Department of Oncology of the Fourth Hospital of Hebei Medical University from November 2016 to November 2018,and analyzed the clinical pathological characteristics,Recurrence and metastasis,genetic testing,and focus on the treatment of patients with different genotypes and the corresponding prognosis.Results:1 Among the 1652 lung cancer patients admitted in 2 years,553(33.5%)were inoperable patients with advanced non-squamous non-small cell lung cancer,of which 480 were detected by gene detection,and the detection rate was 86.8%.Of the 480 patients,423(88.1%)had distant metastases at the first diagnosis.Among them,166 cases had multiple organ metastasis(number of distant organ metastasis?2),and bone metastasis was the most common(38.1%)in organ metastasis,followed by pleural metastasis(25.6%),brain metastasis(18.1%)and liver metastasis(12.3%).2 All the 480 patients with advanced non-squamous non-small cell lung cancer were sent for genetic testing,among which 384 patients(80%)were sent for lung-related driving gene testing(including EGFR,BRAF,KRAS,NRAS,her-2,MET,ROS1 and ALK).72.3% of the samples were lung or lymph node puncture tissue or pleural effusion,while the plasma samples were 12.3%.Among patients with driver gene mutation,EGFR sensitivity mutation accounts for 218 cases(45.4%),with a small amount of ALK fusion mutation(5%)and ROS1 rearrangement(0.4%).Of the 137 patients who failed first-line EGFR-TKI targeted therapy,60 cases(43.8%)received T790 M detection,and 36(60%)were T790 M positive.3 In predicting the immune checkpoint inhibitor treatment the curative effect of markers,there are 18 cases(3.5%)patients apoptosis protein 1(programmed cell death 1,PD-1)and its ligand 1(PD-1 ligand,PD-L1)detection,among them 6 cases(33.3%)PD-L1 positive cells expression rate > 50% of patients are sensitivity EGFR mutation negative;Among the 12 patients with pd-l1 expression < 50%,the positive and negative patients with EGFR sensitive mutation accounted for 50% respectively.4 The first-line treatment of 480 patients with advanced non-squamous non-small cell lung cancer was mainly platinum-based double chemotherapy or TKI targeted therapy.198(83.9%)patients with negative driver mutation received first-line chemotherapy,with a median cycle of 4 cycles.218 patients(89.9%)with positive mutations received the corresponding targeted therapy in the first line,including Gefitinib,Erlotinib,Icotinib and Crizotinib,no first-line treatment choice second or third generation TKI patients.Twenty patients with negative EGFR mutations received first-generation EGFR-TKI therapy with median PFS of 2.5 months and median OS of 9 months.5 The median PFS of 480 patients with advanced non-squamous non-small cell lung cancer who received first-line treatment was 8 months,the median OS was 19 months,and the OS at 6 months,1 year and 2 years were 86.7%,67.5% and 29.8%,respectively.6 The median PFS of patients in the first-line Gefitinib,Erlotinib and Icotinib treatment groups were 9 months,9 months and 8 months,respectively,and the median OS was 23 months,28months and 23 months,with no significant difference between the groups(P > 0.05).In addition,the median PFS of the EGFR19 exon deletion mutation and 21 exon L858 R mutation were 9 months and 8 months,respectively.The median OS was 17 months and 16 months,respectively.there was no statistical difference between the two groups(P > 0.05).7 As of the end of follow-up,patients received different treatments after the failed targeted therapy.58 patients(42.3%)switched to the third-generation TKI.The median PFS was 7 months,and the median OS was 30 months.23 patients(16.8%)received platinum-based double chemotherapy.The median PFS was 4 months,and the median OS was 20 months.39 patients(28.5%)received the best supportive care with a median OS of 15 months.8 Patients(87 cases)with brain metastasis were found to have a median PFS of 7 months and a median OS of 16 months.9 PFS(HR: 1.735,95%CI: 1.256-2.365;P=0.008)and OS(HR: 1.364,95%CI: 1.299-1.406;P=0.032)in patients with PS score?2 at the time of initial diagnosis were shorter than those with PS score 0-1,first-line TKI patients with PFS(HR: 0.550,95%CI: 0.322-0.754;P=0.021)and OS(HR: 0.744,95%CI: 0.523-0.937;P=0.041)longer than those treated with platinum-based double chemotherapy.First-line treatment PFS of female was longer than that of male(HR:1.079,95%CI: 1.011-1.123;P=0.029),but there was no significant difference in OS(HR: 1.031,95%CI: 0.858-1.265;P=0.440).Age,pathological type,stage,BMI,smoking history,lymph node metastasis,number and location of metastatic organs,and EGFR mutation status all had no effect on patients with first-line treatment of PFS and OS.Conclusions:1 The rate of genetic detection in patients with advanced non-squamous non-small cell lung cancer is high.Among the EGFR-sensitive mutations,EGFR19 exon deletion mutation and 21 exon L858 R mutation ratio were equivalent.The first-line treatment of patients with negative mutation in driving genes was mainly chemotherapy,while targeted treatment was the main treatment for positive patients.The second-line treatment mode mainly includes chemotherapy,targeted therapy and optimal supportive therapy.2 The first-line Gefitinib,Erlotinib and Icotinib were equally effective.The median PFS of the EGFR19 exon deletion mutation and 21 exon L858 R mutation were similar.Targeted therapy for patients with negative gene mutation was shorted-lived,and chemotherapy was preferred.3 At the initial diagnosis,the PFS and OS with PS score 2 were both shorter than those with PS score 0-1.The PFS and OS treated with TKI were longer than those treated with platinum double chemotherapy in first-line patients,and the PFS in first-line treatment in women were longer than those treated with platinum double chemotherapy in men,but there was no significant correction with OS.4 Standardized genetic testing and targeted drug therapy can prolong PFS and OS in patients with advanced non-squamous non-small cell lung cancer.