To Investigate The Prognostic Factors And The Significance Of Tki In Advanced Nsclc With Wild-Type Egfr

To investigate the prognostic factors and the related problems of TKI therapy about NSCLC patients with wild-type EGFR. We performed a review of 90 advanced NSCLC patients with wild-type EGFR in the 4th Hospital, Hebei Medical University from January 2015 to December 2016. Analyse the prognostic factors for survival; observe the DCR, ORR, PFS, OS, side effects’ differences between chemotherapy and TKIs groups according to the second-line treatment after failure in platinum. 1 PS, stage, surgery, blood coagulation, metastasis, NSE, CY-211 level were correlated with the prognosis (P<0.05). Multivariate Cox Regression analysis revealed the lower PS score, more organs metastasis, the serum CY-211 beyond the upper limit of normal were independent prognostic factors in NSCLC patients with wild-type EGFR, the risk of death increased respectively 2.589, 1.986, 3.546 (1/0.282) times (P=0.041, P =0.006, P =0.007). 2 In the second-line treatment, 30 patients experienced the failure of platinum were divided into chemotherapy group and TKI group. The TKI group were elderly and had a bad PS. The two groups had no significant differences in ORR, OS, side effects(P>0.05); the mPFS of chemotherapy group extended 2.6 months compared with TKI group (P =0.004); DCR was also better than TKI group (P=0.019). 3 The first-line TKI group had 14 patients, the mOS was 6 months and the mPFS was 2 months. The second-line TKI group including 10 patients, the mOS was 31 months and the mPFS was 3 months (P =0.008, P =0.009). The ORR, DCR and adverse reaction between two groups had no significant differences (P >0.05). 4 40 patients were detected with ALK gene, and fusion mutation was found in 2 patients. There were six patients detecting multiple genes, based on the wild EGFR gene, one patient had EML4-ALK fusion mutation, one had the EGFR A767_V769dup and PI3KCA mutation, one companied with HER-2 mutation, one had the RET, HDAC4, FLT4, NOTGH1, BTK mutations, and one was not associated with other genes variation. 1 Low PS, distant metastasis, serum CY-211 beyond the upper limit of normal were independent adverse prognostic factors in advanced NSCLC patients with wild-type EGFR. 2 There were no significant difference in OS and serious side effects between two groups; the chemotherapy group had a longer PFS and a better DCR. 3 The second-line TKI group had a better OS, PFS compared to the first-line TKI group. 4 EGFR wild-type patients may be combined with other genes variation including EML4-ALK, HER-2, PIK3CA and other mutations, providing an opportunity for precise medicine.