| Objectives To explore the efficacy of EGFR-TKIs combined with apatinib in NSCLC patients with acquired resistance of original EGFR-TKIs who have progressed slowly after EGFR-TKIs treatment.Methods The research retrospectively collected 57 patients with advanced non-small cell lung cancer who were treated in Tangshan people’s Hospital from January 1,2016 to September 30,2019.57 patients who had progressed slowly after EGFR-TKIs(gefitinib,erlotinib,icotinib or osimertinib)treatment were treated with original EGFR-TKIs combined with apatinib.The ORR,DCR,m PFS,m OS and safety of the patients were retrospectively analyzed.According to the sexes,ages,type of EGFR-TKIs drugs,timing of combined treatment(second-line or ≥third-line),with or not distant metastasis,with or not pleural effusion,clinical stage(Ⅲ stage or Ⅳ stage),ECOG score,smoking history and EGFR type,patients were divided into ten subgroups to explore the relationship between subgroups and prognosis.Results 1 Curative effect evaluation of 57 patients: 0 case reached CR.21 cases reached PR.31 cases reached SD.5 cases reached PD.ORR was 36.84%.DCR was 91.23%.m PFS was 4.33 months.m OS was 9 months.2 Univariate survival analysis showed that the m PFS was longer in timing of combined treatment(second-line),without distant metastasis,without pleural effusion,Ⅲ stage,ECOG score(0～1 score)than that in timing of combined treatment(≥third-line),with distant metastasis,pleural effusion,Ⅳ stage,ECOG score(2 scores),and the differences were statistically significant(χ2=6.400,P=0.011;χ2=6.430,P=0.011;χ2=20.284,P<0.001;χ2=6.430,P=0.011;χ2=12.251,P<0.001).In addition,the m PFS in the female group was better than that in the male group.Besides,the m PFS in the age≤65 was also better than that in the age>65.But the differences were not statistically significant((χ2=0.933,P=0.334;χ2=3.732,P=0.053).In terms of the m OS,analysis also showed that the m OS was longer in timing of combined treatment(secondline),without distant metastasis,without pleural effusion,Ⅲ stage,ECOG score(0～1 score)than that in timing of combined treatment(≥third-line),with distant metastasis,pleural effusion,Ⅳ stage,ECOG score(2 scores),and the differences were statistically significant(χ2=6.365,P=0.012;χ2=4.329,P=0.037;χ2=16.204,P<0.001;χ2=4.329,P=0.037;χ2=9.533,P=0.002).The m OS in the female group was better than that in the male group.Besides,the m OS in the age≤65 was also better than that in the age>65.The m OS in the without smoking history was better than that in the with smoking history too.But the differences were not statistically significant(χ2=2.176,P=0.140;χ2=2.618,P=0.106;χ2=0.451,P=0.502).Multivariate survival analysis showed that pleural effusion(χ2=9.23,P=0.002;χ2=7.71,P=0.006)was independent factor influencing both m PFS and m OS.3 The main drug-related side effects were hypertension,hand-foot syndrome,fatigue,loss of appetite,liver dysfunction,diarrhea,albuminuria,paronychia,edema and hemoptysis.All of the adverse events were Ⅰ～Ⅱ grade and could be controlled.Conclusions 1 The EGFR-TKIs reuse with apatinib in advanced NSCLC patients who have progressed slowly after EGFR-TKIs treatment have significant effect and good security.The m PFS is 4.33 months.The m OS is 9 months.2 Survival analysis showes that timing of combined treatment(second-line),without distant metastasis,without pleural effusion,Ⅲ stage,ECOG score(0～1 score)are associated with a good prognosis.The COX regression analysis shows that pleural effusion is independent factor influencing both m PFS and m OS.Figure22;Table7;Reference 146... |
