Background and objective: The appearance of highly effective and low toxic drugs enables an increasing number of advanced non-small cell lung cancer (NSCLC) patients to receive third-line therapy. No other standard choice for third-line therapy aside from erlotinib is possible. This study respectively explores the efficacy and safety of single chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), and doublet chemotherapy in advanced NSCLC third-line treatment.
Methods: This study included 115 NSCLC patients in the stage IIIb or IV who were retrospectively reviewed to investigate the differences of survival time between different treatments. Univariate and multivariate analyses were conducted based on the Kaplan-Meier method and Cox proportional-hazards model.
Results: The median progression free survival (PFS) values in the single agent, EGFR-TKIs and doublet groups were 2.30, 3.17 and 2.37 months, respectively (P=0.045). The median overall survival from the initiation of the third-line treatment were 8.00, 10.40 and 7.87 months in the three groups (P=0.110). The rates of stage III-IV toxicities were 33.3%, 18.2% and 68.8% (P<0.001), respectively. After the third-line treatment, the PFS was significantly increased in patients with a performance status (PS) of 0 to 1 (P<0.001), and the survival time was prolonged in patients who never smoke (P=0.011), have good PS (P<0.001), and have disease control after both first- and second-line treatments (P=0.044) using multivariate analysis.
Conclusion: Advanced NSCLC patients who never smoke, have good PS scores, and have good disease control from the first- and second-line therapies could benefit more in third-line treatment. EGFR-TKIs therapy showed increased PFS compared with single and doublet agents.
背景与目的: 随着高效低毒药物的出现，越来越多的晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者有机会接受三线治疗，但目前三线的标准治疗除厄洛替尼外尚无其它选择方案。本研究旨在比较单药化疗、靶向药物与双药联合化疗在晚期NSCLC患者三线治疗中的疗效与安全性。
方法: 回顾分析115例Ⅲb期/Ⅳ期接受三线治疗的NSCLC患者的疗效及生存状况。采用Kaplan-Meier曲线、Cox多因素生存分析模型进行单因素和多因素分析。
结果: 单药组、靶向治疗组与双药联合组中位无进展生存时间（progression free survival, PFS）分别为2.30个月、3.17个月和2.37个月（P=0.045），三线治疗后的中位生存时间（overall survival, OS）分别为8.00个月、10.40个月和7.87个月（P=0.110），Ⅲ度-Ⅳ度毒性反应发生率分别为33.3%、18.2%和68.8%（P < 0.001）。多因素分析显示体能状况（performance status, PS）评分（P < 0.001）是PFS的独立预后因素，既往无吸烟史（P=0.011）、PS评分0分-1分（P < 0.001）和一二线治疗疗效获得疾病控制（P=0.044）是三线治疗OS的独立预后因素。
结论: PS评分较好、既往不吸烟和一二线治疗疗效疾病控制的患者在三线治疗中更能获益，与化疗单药或双药相比靶向药物组PFS显示出优势。