Effectiveness of Erlotinib as the Sennd-line Therapy in Patients with Advanced NSCLC
|School||Dalian Medical University|
|Keywords||Erlotinib Targeted therapy Second-line treatment Non-small cell lung cancer|
Objective: In recent years, numerous studies showed that epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (EGFR-TKI) erlotinib (Erlotinib, 0SI-774. Trade name: Tarceva) chemotherapy in the treatment of advanced NSCLC After the failure of the second and third-line therapy achieved a significant effect. Phase III clinical trial (BR.21) and IV clinical trials (TRUST) confirmed erlotinib in second-line treatment of advanced NSCLC has obvious benefits, and achieved significant improvement in PFS. This study of our hospital with advanced non-small cell lung cancer patients treated with chemotherapy failed erlotinib for second-line treatment, to evaluate the clinical efficacy and adverse reactions. Methods: June 2008 - April 2010, First Affiliated Hospital of Dalian Medical University, with complete data 60 cases Ⅲ B, Ⅳ of advanced non-small cell lung cancer patients with oral erlotinib 150mg, once-daily second-line treatment until disease progression or appear not tolerate serious adverse reactions. The study enrolled a total of 60 patients, 39 males, 21 females, median age 65 years (36 years old -78 years old), 38 cases of adenocarcinoma, squamous cell carcinoma 22 cases, ECOG score 0-1 in 39 cases, 2 minutes 21 cases, including 27 cases of stage Ⅲ B, Ⅳ of 33 cases, 34 cases of former smokers, non-smokers 26 cases. Before treatment, the patients underwent chest CT, abdominal CT, brain MRI, tumor markers, blood and liver and kidney function tests as a baseline assessment. Closely observed during treatment with clinical symptoms, signs, treatment six weeks after the review of the physical and chemical tests, imaging evaluation of efficacy, later evaluated once every six weeks, and using Response Evaluation Criteria in Solid Tumors (RECIST criteria) the efficacy of the patient assessment, complete remission (CR), partial response (PR), stable (SD) and progression (PD). According to NCI Common Toxicity grading standards (third edition) evaluated adverse reactions. Results: There were 60 patients evaluable for efficacy, and no response (CR) patients, PR was 14 cases (23.3%), SD was 30 cases (50.0%), objective response rate (ORR) was 23.3% and the disease control rate (DCR) was 73.3%; PD of 16 cases (26.7%), median progression-free survival (mPFS) was 5.5 months, median survival time (MST) was 12.5 months, 1-year survival rate was 62.5%. Group comparison showed that gender, age, histological type, tumor stage at the ORR and DCR were not statistically significant differences in efficacy, P gt; 0.05; while on the DCR, PS score 0-1 points better than the PS score 2 points patient ( 89.8% vs.42.8%, P = 0.007), non-smokers better than smokers (91.2% vs.50.0%, P = 0.018), the difference was statistically significant. OK Log-rank test analysis Univariate survival differences, statistical analysis shows age, adenocarcinoma, PS score, stage of disease, smoking status, and short-term effect on the progression-free survival difference was statistically significant, P lt; 0.05, while After a median survival on, PS score, stage of disease, smoking status, the difference was statistically significant, P lt; 0.05. Erlotinib common adverse reactions were mild, mostly Ⅰ, Ⅱ degree of skin toxicity and diarrhea, weight loss is not due to adverse events or withdrawal. Observed adverse reactions were rash 78.3% (47/60), diarrhea 51.7% (31/60), followed by loss of appetite 38.3% (23/60), pruritus 26.7% (16/60), nausea 30.0 % (18/60), dry skin, 23.3% (14/60), vomiting 20.0% (12/60), oral mucositis 13.3% (8/60), abnormal liver function (ALT, AST increase) 13.3% ( 8/60), abdominal pain 8.3% (5/60), all patients with no interstitial pneumonia and blood toxicity occurs. Conclusion: This study showed that erlotinib used in second-line treatment of advanced non-small cell lung cancer patients, the clinical benefit rate was higher adverse reactions were mild, good compliance, can be used as chemotherapy in advanced non-small cell lung cancer patients with second-line treatment failure one of the options.