The Efficacy And Safety Of Patients With EGFR-T790M Mutation-positive Advanced Non-small Cell Lung Cancer With Different Sources Osimertinib Treatment

Objective: Through follow-up and observation of the efficacy and safety of patients with advanced non-small cell lung cancer(NSCLC)who took Osimertinib or Osimertinib generics on the second line of our hospital,and further mastered the first-line use of The first generation of epidermal growth factor receptor-tyrosine kinase inhibitors,(EGFR-TKIs)of patients with advanced NSCLC,after the disease has progressed and the second line takes the third generation EGFR-TKI Osimertinib treatment,clear Osimertinib in improving the quality of life and extend edhea' status,Provide smored clinical evidence.Methods: Patients with advanced non-small cell lung cancer with a positive T790 M mutation after the progress of Treatment of First Line EGFR-TKI from January 1,2016 to December 31,2019 were included in this study,and follow-up observed the efficacy and safety of patients taking Osimertinib.The evaluation of efficacy was based on RECIST version 1.1 criteria,and treatment-related side reactions were evaluated using CTCAE version 4.0.Using SPSS22.0 statistical software for statistical analysis and Graph Pad Prism 8,Origin 2017 software mapping,survival time using Kaplan-Meier method,application of log-rank-method to test survival differences,rate comparison using the test,the rate of comparison using the chi square test,For the theoretical frequency of 5 using Fisher's exact probability method,the difference with P<0.05 is statistically significant.Results: At the end of follow up,Of the 398 patients with first-generation EGFR-TKI treatment progression of non-small cell lung cancer,only about 20%(80/398)had the opportunity to take third-generation EGFR-TKI Osimertinib on the second line;There were 29 people in the Osimertinib generics group and Osimertinib group 41 people,the age of the Osimertinib group was 55 years old,the Osimertinib generics group was 61 years old,and there was no significant difference in baseline characteristics between the two groups;and a total of 29 people took Osimertinib from different sources before the medics for advanced non-small cell lung cancer after Osimertinib was given a generation of EGFR-TKI mutations.Of these,86.2%(25/29)of the patients took Osimertinib generics,the type of medical insurance mainly to the staff health insurance 48.28%(14/29),the new co-workers accounted for 44.82%(13/29),2 patients with residential health insurance,while only 13.8%(4/29)of patients taking Osimertinib,After Osimertinib was included in the medicare reimbursement policy,a total of 41 people took Osimertinib from different sources,of whom 90.2%(37/41),9.8%(4/41)of patients taking Osimertinib,51.2%(21/41)for new farmers,36.58%(15/41)and 14 people with self-funded health insurance.Median PFS(9 months vs 8 months,HR for 8 months;95%CI,0.39-1.14;P=0.0922),median OS(24 months vs 12 months;HR=0.21;95%CI,0.10-0.44;P=0.0005),the median OS of Osimertinib generics group is significantly lower than that of Osimertinib;19 exoskeleton-missing patients with T790 M mutation group and 21 after advances in the first generation of EGFR-TKI treatment Median PFS(8 months vs 9 months;HR=1.02,95% CI,0.59-1.77,P= 0.9390)in patients with L858 R mutation after advance synomes with the first generation of EGFR-TKI treatment and median OS with no significant differences(13 months vs 16 months;HR=1.3,95% CI,0.60-2.84,P=0.5029).In terms of safety,the majority of adverse drug reactions in both groups were 1-2,the incidence of level 3 adverse reactions was 12% in the Osimertinib group,20.7% in the Osimertinib generics group,and no adverse reactions of 4 or more were observed in both groups.Conclusion: Only about 20% of patients in the region have the opportunity to take third-generation EGFR-TKI Osimertinib on the second line after progressin a generation of EGFR-TKI treatment.the economic reason is that patients choose Osimertinib treatment is one of the important factors;Patients who took Osimertinib's advanced non-small cell lung cancer had a longer total survival and were safer than patients taking the Osimertinib,and the common adverse reactions of Osimertinib patients with advanced EGFR mutations were diarrhea,rash,enteratis,dry skin,stomatitis,itching of the skin,constipation,etc.There were no unexpected adverse reactions.The incidence of paralytic reactions of Osimertinib generics of more than 3 levels was significantly higher than Osimertinib.