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Clinical Observation of70Patients with Brain Metastases

Author: LiZuo
Tutor: GaoYaJie
School: Dalian Medical University
Course: Oncology
Keywords: non-small cell lung cancer brain metastases targeted therapyEGFR-TKIs chemotherapy
CLC: R739.41
Type: Master's thesis
Year: 2013
Downloads: 16
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Abstract


Objective: In this study, retrospective observational comparison of clinicalefficacy and adverse reactions of systemic therapy[targeted therapy (gefitinib anderlotinib) and systemic chemotherapy] in70patients with brain metastases.Methods: A total of70patients with brain metastases were enrolled in firstAffiliated Hospital of Dalian Medical University from January2007to January2012.All of these patients had been confirmed non-small cell lung cancer with pathology orcytology and clear intracranial metastases confirmed by CT or MRI. The age range was32-80, mean58.5years;31of these were male and39were female; history of smokingin26cases,44cases no history of smoking;37were adenocarcinoma,26weresquamous cell carcinoma,3were adenosquamous carcinoma,3were large cellcarcinoma and1was bronchioloalveolar carcinoma;45patients’ECOG score were0-1,25patients’ECOG score were2; solitary brain metastasis in21cases, multiple brainmetastases in49cases; primary treatment21,retreatment49;46cases with extracranialmetastases,24cases without extracranial metastases. They were divided into2differentgroups according to drug use, A group-targeted therapy group (including gefitinib20cases, erlotinib11cases), the completion of the treatment time for1-18months, with anaverage of6.8months.; B group-traditional chemotherapy group,39cases of(including pemetrexed23cases,16cases temozolomide) which pemetrexed to repeatedevery21days, temozolomide to repeated every28days, the completion of the treatmentcycles for1-9cycles,and average cycle was3.2. Observe the short-term curative effect,progression free survival,1-year survival rate and side-effect of the two groups.Curative effect was evaluated by Response Evaluation Criteria In SolidTumors(RECIST),and adverse reaction by WHO Cancer Drug Toxicity AssessmentStandards into0-Ⅳ degrees. The general information between groups, curative effectand adverse reaction comparison use the X2inspection, survival analysis usingKaplan-Meier statistical processing and Log-Rank inspection. Results: The overall disease control rate of the70patients was25.7%(18/70), thedisease control rates were54.3%(38/70), the median progression-free survival was4.4months and1-year survival rate was35.7%.In targeted therapy group (n=31) and chemotherapy group (n=39): theORR(CR+PR) was35.5%(11/31) and17.9%(7/39),respectively, has no significantdifference (P>0.05); DCR(CR+PR+SD) was71.0%(22/31) and41.0%(16/39),respectively, there was significant defference (P=0.012);1-year survival rates were41.9%and30.8%, respectively,the difference hae no statistically significant (P>0.05);mPFS were6.5months and4.0months, respectively,the difference has statisticallysignificant (P=0.033).The most common adverse reactions of the chemotherapy group weremyelosuppression and nausea and vomiting: Ⅰ-Ⅳ degree andⅢ-Ⅳ degree of bonemarrow suppression incidence were46.2%and7.7%,Ⅰ-Ⅳ degree and Ⅲ-Ⅳ degree ofnausea and vomiting incidence were51.3%and5.1%; bone marrow suppression andnausea and vomiting were higher than the targeted therapy group (P<0.001); The mostcommon adverse reactions of the targeted therapy group were rash and diarrhea: I-IVdegree and Ⅲ-Ⅳ degree rash incidence were54.8%and9.6%,Ⅰ-Ⅳ degree and Ⅲ-Ⅳdegree diarrhea rates were29.0%and3.2%, the incidence of rash was significantlyhigher than the chemotherapy group (54.8%vs10.3%, P<0.001). The patients with skinrash occurred in targeted therapy group, effectiv rate was76%(13/17) e, invalid ratewas24%(4/17), the difference has statistically significant (P<0.001).Subgroup analysis: in gefitinib group(n=20), erlotinib group (n=11), pemetrexedgroup (n=23), temozolomide group (n=16): the ORR(CR+PR) was30.0%(6/20),45.5%(5/11),21.7%(5/23) and12.5%(2/16), respectively, has no significant difference (P>0.05); DCR(CR+PR+SD) was70.0%(14/20),72.7%(8/11),43.5%(10/23) and37.5%(6/16), respectively, has no significant difference (P>0.05);1year survival rates were40%,45.5%,30.4%and31.3%, respectively, hae no significant difference (P>0.05);mPFS were6.2months,6.5months,3.9months and4.0months, respectively, has nosignificant difference (P>0.05). Four groupsⅠ-Ⅳ myelosuppression rates were10%,0%,60.9%and62.5%,respectively; incidence of nausea and vomiting were15%,9.1%,69.6%and62.5%, respectively; incidence of rash were55%,54.5%,8.7%and12.5%,respectively, all of the differences have statistically significant (P<0.05).Conclusion:1. The overall objective response rate of70patients of NSCLCpatients with brain metastases was25.7%, the disease control rate was54.3%, the median progression-free survival was4.4months and1year survival rate was35.7%.2.The ORR and mPFS of the the EGFR-TIKS targeted therapy group are betterthan chemotherapy group,both differences have statistically significant; the DCR and1year survival rate have a slight advantage, but has no significant difference.3. The comparison of subgroups in gefitinib group, erlotinib group, pemetrexedgroup and temozolomide group, the ORR, DCR, mPFS and1year survival rates haveno statistically different.4. Bone marrow suppression and nausea and vomiting were the main adversereactions of chemotherapy,and rash of EGFR-TKIs targeted therapy,,both differenceshave statistically significant. No patients died, all of the adverse reactions were able totolerate. The rash maybe can be used as a predictor for the evaluation of efficacy.

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CLC: > Medicine, health > Oncology > Nervous system tumors > Intracranial tumors and brain tumors
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