Clinical Observation Of EGFR-TKI Combined With 89sr In The Treatment Of Non-small Cell Lung Cancer With Osteoblastic Reaction

Objective:To observe the efficacy and safety of EGFR-TKI combined with 89Sr in the treatment of non-Small cell lung cancer patients with osteoblastic reaction.and to provide new ideas and basis for the multiple bone metastases non-small cell lung cancer.Methods:Patients who diagnosed as non-small cell lung cancer with EGFR mutation-positive and multiple(three or more)osteolytic bone metastases treated in the Oncology Department of Yibin Second People's Hospital from June 2015 to June 2018 were retrospectively collected.All patients were initially treated with EGFR-TKI,and CT imaging was-used to determine whether osteogenic reactions occurred.Among them,patients who were effective in treatment but did not develop osteogenic reaction(group A without osteogenesis)continued to take EGFR-TKI.Patients with osteogenic reaction were divided into EGFR-TKI monotherapy group(group B without combination group)and EGFR-TKI combined with 89Sr group(group C combined group).1.To observe the probability of osteogenic reaction and median osteogenic response time after EGFR-TKI treatment.2.To compare bone progression-free survival(BPFS),profession-free survival(PFS)and side effects in groups A and B,and groups B and C.Results:Thirty seven patients were included in this study.Among them,25 cases had osteogenic reaction,12 cases had no osteogenic reaction,and the osteogenesis rate was 67.57%.The median osteogenic response time was 54 days(range,29-86 days).There were 12 cases in group A,15 cases in group B,and 10 cases in group C.Compared with group A,group B had BPFS(8.53months vs 12.70months,P=0.030),PFS(6.67months vs 11.50months,P=0.000),the differences are statistically significant.Compared with group B,group C had BPFS(12.70months vs 17.60 months,P=0.039)and PFS(11.50 months vs 12.23 months,P=0.136),the BPFS were statistically significant.There were no grade 3/4 adverse events in all three groups.Conclusion:1.The combination of EGFR-TKI and 89Sr after osteogenic reactions induced by EGFR-TKI can delay the recurrence of bone metastasis.2.Patients treated with EGFR-TKI alone which with osteogenic reactions may prolong the progression-free survival time than patients without osteogenic reactions.3.The side effects of EGFR-TKI combined with 89Sr were tolerable.