The Retrospective Study Of The Efficacy Of EGFR-TKI Combined With Local Therapy Versus EGFR-TKI Monotherapy In Advanced NSCLC

Objective: Lung cancer is one of the malignant tumors with a high mortality in China and the world.Non-small cell lung cancer(NSCLC),including squamous cell carcinoma,adenocarcinoma and large cell carcinoma,accounts for about 85%.With the gradually deepening understanding of the gene,epidermal growth factor receptor-tyrosine kinase inhibition(EGFR-TKI)is the standard first-line treatment for advanced NSCLC patients with EGFR active mutations.However,most patients develop acquired drug resistance 9to 14 months after treatment with first/second-generation EGFR-TKI.This study retrospectively analyzed the clinical data of 102 patients with advanced NSCLC who received first-line EGFR-TKI treatment in the First Affiliated Hospital of China Medical University from November 2012 to May 2020,the purpose of this study were to explore the prognosis of EGFR-TKI alone and EGFR-TKI combined with local therapy.Methods: The medical data of patients diagnosed with advanced NSCLC with EGFR active mutation and without central system metastasis in the First Affiliated Hospital of China Medical University from November 2012 to May 2020 were collected and analyzed.All patients received primary treatment with first-line EGFR-TKI and response evaluation criteria in solid tumors(RECIST)version 1.1 were used to evaluate the efficacy of complete response(CR),partial remission(PR)and stable disease(SD).Patients were divided into two groups.Group A was test group,with patients taking EGFR-TKI combined with local therapy while group B was control group,with patients taking EGFRTKI alone.Progression-free survival(PFS)and overall survival(OS)were observed and analyzed between the two groups.SPSS 25.0 and R software were used for statistical analysis,Kaplan-Meier method was used for survival analysis and depict survival curve.Log-rank test was used to describe the differences of PFS and OS.Hazard ratio(HR)and95% confidence interval(95%CI)were calculated by Cox proportional hazards models.P< 0.05 was considered statistically significant.Results: The data of 123 patients were collected and analyzed.41 patients in group A and82 patients in group B were included in the study.The median PFS in group A(combined local treatment group)was 21 months,and that in group B(EGFR-TKI alone group)was11 months(p<0.001).The median OS in group A(combined local treatment group)was30 months,and that in group B(EGFR-TKI alone group)was 21 months(p=0.12).Subgroup analysis showed that age,gender,smoking history,best efficacy,gene mutation and other subgroup factors,EGFR-TKI combined with local treatment had better clinical benefits for PFS.After propensity score matching(PSM),the median PFS in A ’group was significantly longer than that in B’ group(21 months vs 12 months,p=0.008).The median OS in A ’group was longer than that in B’ group(31 months vs 22.5 months,p=0.84).The differences were not statistically significant.The median PFS was 18 months vs 19.5months(p=0.73)and median OS was 29 months vs 30.5 months(p=0.81)for intrapulmonary local therapy versus bone radiotherapy,respectively.The median PFS of intrapulmonary radiotherapy versus other intrapulmonary local treatments was 18.5months vs 17 months(p=0.67)and median OS was 29.5 months vs 26 months(p=0.10).There were no statistically significant differences.Conclusions:Advanced NSCLC patients with EGFR active mutations and without central system metastases could obtain a better PFS from EGFR-TKI combined with local treatment than EGFR-TKI alone,and delay the acquired resistance of EGFR-TKI.Subgroup analysis showed that a variety of clinical characteristics have PFS advantages.