Efficacy and influence factors of icotinib hydrochloride in treating advanced NSCLC

In the most parts of the world, the lung cancer ranks on the top list between global tumor occurrence and mortality, which seriously threatens the human health and life. Lung cancer mainly includes non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), in which NSCLC accounts for 80% and has a five-year survival rate of only 12-15%1,2. Due to the occult features of lung cancer at the early stages, over 70% patients with lung cancer have missed the chance of surgery when they felt ill. Moreover, less than 1/3 NSCLC patients are early diagnosed and subjected to excision. Although the traditional chemotherapy can reduce mortality to some extent, it just only increases the one-year survival rate from 20% to 29%3. Also, the traditional chemotherapy has great toxicity and side effects that are intolerable for advanced patients with poor health conditions. Before application of the targeted therapy to clinical treatment, the systemic chemotherapy was the primary method of treating advanced NSCLC. However, with the development of molecular biology and further study of tumor signal transduction, the targeted therapy has been a significant method4. Epidermal growth factor receptor (EGFR) is a major signal transduction pathway, which regulates onset, growth and apoptosis of tumor, and it was turned out in many studies that NSCLC with EGFR mutants has special clinical characteristics and progressions. The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been widely applied to the second-line therapy of advanced NSCLC. Through working on the epidermal growth factor receptor tyrosine kinase, it was discovered that the EGFR can block the signal transduction to inhibit tumor growth, thereby prolonging the life of patients, especially lung cancer patients with Abstract. – OBJECTIVE: To evaluate the efficacy and safety of icotinib hydrochloride in the treatment of patients with advanced non-small cell lung cancer (NSCLC) and discuss the influence factors on efficacy. PATIENTS AND METHODS: 120 treatment-experienced patients confirmed by pathology or cytology with stage III B-IV non-small cell lung cancer took icotinib hydrochloride and erlotinib orally until the occurrence of disease progression or serious adverse reactions. Then, the efficacy of icotinib hydrochloride and the related influence factors were analyzed. RESULTS: In icotinib hydrochloride group, the response rate and the disease control rate were 30.00% and 65.00%, and the median progression-free survival time was 179 days (95% CI: 103.21-254.78); in erlotinib group, the response rate and the disease control rate were 25.00% and 56.70%, and the median progression-free survival time was 121 days (95% CI: 95.05-146.94). Moreover, the objective response rate and the disease control rate of second-line therapy were both superior to the third-line and above therapy. The objective response rate of patients with complete response/partial response/stable disease after the first-line therapy was higher than that of patients without response after the first-line therapy (p<0.05), and the significant differences existed in the objective response rate and the disease control rate among mutant group, wild-type group, and unknown group (p<0.05). The response rate and the disease control rate of erythra group were higher than those of non-erythra group (p<0.05). It was showed in the univariate analysis that the progression-free survival was correlated with the smoking status and the epidermal growth factor receptor gene mutations. CONCLUSIONS: The icotinib hydrochloride is effective and safe in treating the treatment-experienced patients with advanced NSCLC, especially for patients with sensitive mutations.