Clinical efficacies of Afatinib and cisplatin combined with pemetrexed in treatment of advanced non-small cell lung cancer

doi:10.3877/cma.j.issn.1674-6902.2020.04.008

Abstract

Abstract:

Objective

To investigate the difference of clinical efficacies of Afatinib and cisplatin combined with pemetrexed respectively in the treatment of the patients with advanced EFGR mutant non-small cell lung cancer (NSCLC) so as to determine the clinical efficacy of Afatinib.

Methods

A total of 107 patients with advanced EFGR mutant NSCLC treated in our hospital from March 2016 to September 2017 were selected for this study. Fifty-one patients treated with cisplatin+ pemetrexed were taken as the control group, while fifty-six patients treated with Afatinib+ pemetrexed were taken as the experimental group. The clinical efficacies, the progression-free survival time (PFST), and the overall survival (OS) were observed for all the patients.

Results

The proportions of ORR and DCR in the experimental group were significantly higher than those of the control group (53.57% vs. 31.37% and 85.71% vs. 66.67%, respectively, P<0.05). The PFST and OS were significantly higher in the experimental group than the control group (7.2 months vs. 6.0 months and 11.75 months vs. 9.5 months, respectively, P<0.05). After treatment, the neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and cytokeratin 19 fragment (CYFRA21-1) of the experimental group were lower than those of the control group [(11.79±8.51) ng/ml vs. (15.26±8.22) ng/ml, (14.54±8.77) ng/ml vs. (18.37±9.35) ng/ml, and (3.45±2.68) ng/ml vs. (5.41±3.54) ng/ml, respectively, P<0.05]. The incidences of nausea and vomiting, renal impairment and hair loss in the experimental group were significantly lower than those of the control group (12.50% vs. 33.33%, 5.36% vs. 27.45%, and 16.07% vs. 35.29%, respectively, P<0.05). The incidence of rash/acne in the experimental group was significantly higher than that of the control group (25.00% vs. 7.84%, P<0.05). After treatment, the physical, psychological, social and overall sensory scores were higher in the experimental group than the control group [(77.41±5.25) scores vs. (72.12±5.08) scores, (74.37±5.40) scores vs. (67.52±5.32) scores, (79.25±5.98) scores vs. (74.32±5.71) scores, and (71.21±5.45) scores vs. (66.61±5.20) scores, respectively, P<0.05].

Conclusion

Afatinib combined with pemetrexed is more effective in the first-line treatment of advanced EGFR mutant NSCLC patients, significantly improves the PFST, the OS and the quality of life of the patients, and has a higher safety, which is worthy of clinical promotion and application.

Key words: Non-small cell lung cancer, Afatinib, Cisplatin, Pemetrexed, Curative effect

Yunwei Zheng, Guoding Huang, Hongquan Lu. Clinical efficacies of Afatinib and cisplatin combined with pemetrexed in treatment of advanced non-small cell lung cancer[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(04): 470-474.

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References 28

1	Hirsch FR, Scagliotti GV, Mulshine JL, et al. Lung cancer: current therapies and new targeted treatments[J]. Lancet, 2017, 389(10066): 299-311.
2	Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances[J]. Translat Lung Cancer Res, 2016, 5(3): 288.
3	Herbst RS, Morgensztern D, Boshoff C. The biology and management of non-small cell lung cancer[J]. Nature, 2018, 553(7689): 446-454.
4	刘　洋，周　莹，阳　韬，等. 血清结合珠蛋白在非小细胞肺癌诊治中的意义[J]. 江苏大学学报(医学版), 2017, 27(6): 530-532.
5	Fennell DA, Summers Y, Cadranel J, et al. Cisplatin in the modern era: The backbone of first-line chemotherapy for non-small cell lung cancer[J]. Cancer Treatment Reviews, 2016, 44: 42-50.
6	王玉娟，王　莉，康　睿. 培美曲塞与吉西他滨分别联合顺铂治疗晚期非鳞非小细胞肺癌效果及对基质金属蛋白酶及其抑制剂水平影响研究[J]. 临床和实验医学杂志，2017, 16(12): 1193-1195.
7	Qin X, Yu S, Zhou L, et al. Cisplatin-resistant lung cancer cell-derived exosomes increase cisplatin resistance of recipient cells in exosomal miR-100-5p-dependent manner[J]. Int J Nanomed, 2017, 12: 3721.
8	Chen N, Fang W, Zhan J, et al. Upregulation of PD-L1 by EGFR activation mediates the immune escape in EGFR-driven NSCLC: implication for optional immune targeted therapy for NSCLC patients with EGFR mutation[J]. J Thorac Oncol, 2015, 10(6): 910-923.
9	Yue D, Xu S, Wang Q, et al. Erlotinib versus vinorelbine plus cisplatin as adjuvant therapy in Chinese patients with stage ⅢA EGFR mutation-positive non-small-cell lung cancer (EVAN): a randomised, open-label, phase 2 trial[J]. Lancet Respirat Med, 2018, 6(11): 863-873.
10	Sharma N, Graziano S. Overview of the LUX-Lung clinical trial program of afatinib for non-small cell lung cancer[J]. Cancer Treat Rev, 2018, 69: 143-151.
11	Park K, Yu CJ, Kim SW, et al. First-line erlotinib therapy until and beyond response evaluation criteria in solid tumors progression in Asian patients with epidermal growth factor receptor mutation-positive non-small-cell lung cancer: the ASPIRATION study[J]. JAMA Oncol, 2016, 2(3): 305-312.
12	罗　健，孙　燕，周生余. 中国癌症患者化学生物治疗生活质量量表的编制[J]. 中华肿瘤杂志，1997，17(6): 437-441.
13	罗华婷，刘　锐，陈　川，等. 阿法替尼治疗EGFR突变型晚期非小细胞肺癌的有效性及安全性的研究[J]. 肿瘤药学，2015, 12(6): 466-471.
14	李　倩，李　宵，李　颖，等. 阿法替尼治疗晚期非小细胞肺癌有效性和安全性的系统评价[J]. 中国循证医学杂志，2017, 9(8): 66-71.
15	潘　燚，谭佩欣. 一线阿法替尼与化疗对EGFR突变伴有脑转移的非小细胞肺癌患者的疗效评价[J]. 循证医学，2016, 16(4): 230-232.
16	杨小菊，欧　娜，赵　盼，等. 阿法替尼治疗肺癌的临床研究进展[J]. 药学进展，2017, 41(4): 297-304.
17	龚　磊. 阿法替尼在非小细胞肺癌中的临床应用进展[J]. 中国肿瘤，2018, 27(11): 857-861.
18	施　霞. 阿法替尼和吉非替尼一线治疗EGFR突变阳性非小细胞肺癌的成本效用分析[J]. 中国现代应用药学，2019, 36(21): 2701-2706.
19	薛英杰，贾　靖，吴　杨，等. 培美曲塞和吉西他滨联合阿法替尼治疗晚期非小细胞肺癌临床效果及安全性分析[J]. 临床误诊误治，2020, 33(2): 57-60.
20	刘　涛，闫平钊，杨小花，等. 阿法替尼在老年非小细胞肺癌患者中的应用[J]. 中国老年学杂志，2019, 39(16): 3931-3933.
21	肖　敬，程晓云，张淑平，等. 固摄扶正抗癌汤联合阿法替尼、培美曲塞治疗非小细胞肺癌的临床效果观察[J]. 解放军医药杂志，2019, 31(11): 20-23.
22	王萌萌，苏颖杰，严颐丹. 临床药师对1例贝伐珠单抗联合阿法替尼治疗宫颈癌复发转移患者的药学监护[J]. 中国临床药学杂志，2019, 28(6): 465-467.
23	贵永贤. 重组人血管内皮生成抑制素联合阿法替尼治疗EGFR突变阳性晚期肺腺癌患者的临床效果[J]. 临床医学研究与实践，2020, 5(5): 29-30.
24	谭鑫宇，张　欢，张　杰，等. 阿法替尼治疗非小细胞肺癌患者致严重的药品不良反应影响因素的Logistic回归分析[J]. 中国医院用药评价与分析，2019, 19(9): 1131-1133.
25	马晓东，胡孟奇，陶强强. 马来酸阿法替尼原料药降解杂质的制备与结构推测[J]. 化学世界，2019, 60(3): 177-181.
26	赵仔君，谷晓媛，张为强，等. 贝伐珠单抗联合阿法替尼治疗非小细胞肺癌临床疗效观察[J]. 海南医学院学报，2019, 25(2): 129-132.
27	龚　磊，卢红阳. 阿法替尼在非小细胞肺癌中的临床应用进展[J]. 中国肿瘤，2018, 27(11): 857-861.
28	薛英杰，贾　靖，吴　杨，等. 阿法替尼分别联合培美曲塞、吉西他滨治疗非小细胞肺癌的临床研究[J]. 空军医学杂志，2019, 35(1): 28-31.

组　别	例数	CR	PR	SD	PD	ORR	DCR
研究组	56	3(5.36)	27(48.21)	18(32.14)	8(15.29)	30(53.57)	48(85.71)
对照组	51	2(3.92)	14(27.45)	18(35.29)	17(33.33)	16(31.37)	34(66.67)
χ²值	-					5.367	5.408
P值	-					0.021	0.020

组　别	例数	CR	PR	SD	PD	ORR	DCR
研究组	56	3(5.36)	27(48.21)	18(32.14)	8(15.29)	30(53.57)	48(85.71)
对照组	51	2(3.92)	14(27.45)	18(35.29)	17(33.33)	16(31.37)	34(66.67)
χ²值	-					5.367	5.408
P值	-					0.021	0.020

组　别		例数	CEA		NSE		CYFRA21-1
组　别		例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组		56	28.66±11.14	11.79±8.51^a	30.14±12.09	14.54±8.77^a	8.81±5.64	3.45±2.68^a
对照组		51	27.95±11.27	15.26±8.22^a	30.93±12.44	18.37±9.35^a	8.96±5.71	5.41±3.54^a
	t值	-	0.327	2.141	0.333	2.186	0.137	3.246
	P值	-	0.744	0.035	0.740	0.031	0.892	0.002

组　别		例数	CEA		NSE		CYFRA21-1
组　别		例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
研究组		56	28.66±11.14	11.79±8.51^a	30.14±12.09	14.54±8.77^a	8.81±5.64	3.45±2.68^a
对照组		51	27.95±11.27	15.26±8.22^a	30.93±12.44	18.37±9.35^a	8.96±5.71	5.41±3.54^a
	t值	-	0.327	2.141	0.333	2.186	0.137	3.246
	P值	-	0.744	0.035	0.740	0.031	0.892	0.002

级　别	组　别	例数	恶心呕吐	肝功能损坏	肾功能损坏	白细胞减少	发热	贫血	脱发	皮疹/痤疮	腹泻
Ⅰ～Ⅱ级	研究组	56	7(12.50)^a	4(7.14)	3(5.36)^a	6(8.93)^a	4(7.14)	3(5.36)	9(16.07)^a	14(25.00)^a	21(31.82)
	对照组	51	17(33.33)	7(13.73)	14(27.45)	13(25.49)	8(15.69)	9(17.65)	18(35.29)	4(7.84)	15(29.41)
Ⅲ～Ⅳ级	研究组	56	2(3.57)	0(0)	0(0)	1(1.79)	0(0)	1(1.79)	0(0)	3(5.36)	3(5.36)
	对照组	51	4(7.84)	2(3.57)	3(5.36)	2(3.57)	2(3.57)	2(3.57)	0(0)	0(0)	3(5.36)

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