Efficacy And Safety Of Anlotinib In The Treatment Of Lung Cancer

Objective: Anlotinib was approved by the National Medical Products Administration on May 8,2018 and August 30,2019 for the third-line treatment of patients with advanced NSCLC and SCLC.However,in the real world,Anlotinib is also used in the second-line treatment of lung cancer.This study aims to evaluate the efficacy and adverse reactions of Anlotinib in the second-line and subsequent-line treatment of lung cancer in the real world,and analyze the effects that affect the efficacy of Anlotinib.relevant factors。Methods: The clinical data of 167 NSCLC/SCLC patients who from2019.1 to 2020.6 were retrospectively collected.According to the treatment plan,they were divided into Anlotinib group of 106 cases and a chemotherapy-only group of 61 cases.SPSS 23.0 software was used for statistical analysis of relevant data.Kaplan-Meier curve and Cox proportional hazards were used to analyze survival differences.P<0.05 indicates statistical differences。Results:1.General characteristics of patients: The comparative analysis of the clinical parameters of the two groups of patients showed that,except for the statistical difference in the number of treatment lines(P<0.05),there was no significant difference between the two groups in terms of gender,age,smoking history,pathological type,ECOG PS score,disease stage,liver and brain metastasis,and history of hypertension(P>0.05)。2.Survival analysis: In the second-line and later treatments,the m PFS(4.1vs3.1 months,P<0.05)and m OS(7.7vs6.4 months,P<0.05)of the anlotinib group were better than those of the chemotherapy alone group.Compared with the chemotherapy alone group,the m PFS(3.4vs2.9 months,P<0.05)and m OS(5.5vs4.5 months,P<0.05)of SCLC patients in the Anlotinib group were significantly prolonged.However,m PFS(4.4vs3.1months,P>0.05)and m OS(9.4vs9.1 months,P>0.05)of NSCLC patients in the anlotinib group did not show significant benefits.In the second-line treatment,the m OS(10.1vs6.7 months,P<0.05)of the Anlotinib group was significantly better than that of the chemotherapy group alone.Compared with chemotherapy alone,the m PFS(4.2vs2.7 months,P<0.05)and m OS(10.0vs4.6 months,P<0.05)of SCLC patients in the Anlotinib group were significantly prolonged,however,the m PFS(3.8vs5.1 months,P>0.05)and m OS(11.2vs12.7 months,P>0.05)of NSCLC patients in the Anlotinib group were not prolonged.In the third-line and later treatments,m PFS(3.8vs2.5months,P<0.001)and m OS(7.4vs5.4 months,P<0.05)in the Anlotinib group were significantly better than those in the chemotherapy group alone.Compared with chemotherapy alone,the m PFS(4.8vs2.3 months,P<0.05)and m OS(9.4vs5.8 months,P<0.05)of NSCLC patients in the Anlotinib group were significantly prolonged.Anlotinib The m OS(5.3vs4.4 months,P<0.05)of SCLC patients in the group was significantly prolonged,but their m PFS(2.9vs3.2 months,P>0.05)was not significantly prolonged。3.Efficacy analysis: There was no significant difference in ORR between the Anlotinib group and the chemotherapy group alone(10.38%vs8.2%,P>0.05),but there was a significant difference in DCR(71.70%vs55.74%,P<0.05).Among them,there was no difference in ORR(10.42%vs12.20%,P>0.05)and DCR(70.08%vs65.58%,P>0.05)of patients in the Anlotinib group and chemotherapy alone group in the second-line treatment.In the third-line and later treatments,although there was no significant difference in ORR between the Anlotinib group and the chemotherapy alone group(10.34%vs0.00%,P>0.05),there was a significant difference in DCR(67.24%vs35.00%,P<0.05)。4.Efficacy factors: In second-line and later lung cancer patients,pathological type,ECOG PS score and treatment plan are independent factors of PFS and OS(P<0.05).In third-line and later treatment patients,treatment plan and ECOG PS score are independent factors affecting PFS and OS(P<0.05),and pathological type is an independent factor affecting OS(P<0.001)。5.Subgroup analysis: Compared with chemotherapy alone,when the age is ≥60 years,the pathological type is small cell lung cancer,the number of treatment lines is third-line and later treatment,the ECOG PS score is 0-1,the disease stage is stage IV,no liver metastasis,no brain metastases in the subgroup of patients,the application of Anlotinib was more beneficial in terms of PFS(P<0.05).The application of Anlotinib in the subgroup of women,age<60 years old,pathological type of small cell lung cancer,2/3 line therapy,ECOG PS score of 0-1,disease stage of stage IV,and no previous history of hypertension can be more beneficial in terms of OS(P<0.05)。6.Safety: The incidence of hypertension(32.80%vs9.84%)and hand-foot syndrome(28.30%vs14.75%)in the Anlotinib group was higher than that in the chemotherapy group,but the incidence of adverse reactions such as leukopenia(4.72%vs37.7%),fatigue(14.15%vs34.42%)and anorexia(16.04%vs39.34%)were lower than those in the chemotherapy group alone,and the number of III-IV adverse events is relatively small。Conclusions:1.Anlotinib has good efficacy and tolerability in the third-line treatment of NSCLC and SCLC,and can be used as one of the standard options for the third-line treatment of patients with advanced NSCLC and SCLC。2.Anlotinib also shows good results and tolerability in the second-line treatment of SCLC,and it can be used as a potential choice for second-line treatment of patients with advanced SCLC。3.Anlotinib has shown certain curative effect in the second-line treatment of NSCLC,which can be used as the direction of second-line treatment for advanced NSCLC patients。4.Patients with good physical fitness and SCLC may benefit more from2-3 line therapy with Anlotinib。...