Abstract
Objective: To explore the efficacy comparison between epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) combined with traditional Chinese medicine (TCM) and single EGFR-TKIs for advanced non-small cell lung cancer (NSCLC).Methods: A total of 91 NSCLC patients with EGFR mutation were divided into an experimental group and a control group (in a ratio of 2:1) to receive TCM and EGFR-TKIs (61 cases) or single EGFR-TKIs (30 cases). Patients in the control group took EGFR-TKIs and those in the experimental group took EGFR-TKIs plus TCM. We analyzed the progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and treatment-related adverse events of two groups.Results: The mPFS of the experimental group and the control group was 12.3 and 8.9 months (P = 0.02), respectively, and the mOS of the experimental group and the control group was 28.2 and 24.2 months (P = 0.02), respectively. Subgroup analysis showed that for the patients with exon 19 deletion mutation (19DEL), mPFS between experimental group and control group was 12.7 and 10.1 months, respectively (P = 0.12). For exon 21 deletion mutation (L858R), the PFS of two groups was 10.8 vs. 8.2 months, respectively (P = 0.03). The subgroup analysis also showed that, for the patients with exon 19 deletion mutation, mOS between the experimental group and the control group was 30.3 and 28.7 months, respectively (P = 0.19). For exon 21 deletion mutation, the mOS of two groups was 25.5 vs. 21.3 months, respectively (P = 0.01). The DCR of the experimental group and the control group was 93.3% and 80.1%, respectively (P = 0.77). Grade 3–4 treatment-related adverse events were less common with the experimental group (11.48%) than the control group (26.67%).Conclusion: For NSCLC patients with EGFR mutation, EGFR-TKIs combined with TCM had a certain effect to prolong mPFS and mOS, compared with the use of EGFR-TKIs alone, especially for the patients with L858R. This conclusion has a significant effect on improving the survival of NSCLC patients after EGFR-TKIs resistance. It deserves further study.
Highlights
Lung cancer ranks first in the incidence and mortality of malignant tumors in China, accounting for 18% of newly diagnosed cases in 2018, and more than 690,000 people died as a result [1]
The mPFS of the experimental group treated with EGFR-TKIs and traditional Chinese medicine (TCM) was 12.3 months, which was 3.4 months longer than the 8.9 months mPFS of the control group only using EGFRTKIs [Figure 1, hazard ratio (HR) = 0.46, 95% CI = 0.23–0.94, P = 0.002]
By reviewing many domestic and foreign experimental studies on the treatment of tumors with TCM, we found that TCM can effectively improve the sensitivity of radiotherapy and chemotherapy, minimize the toxic and side effects of radiotherapy and chemotherapy, reduce the recurrence and metastasis of tumor, completely cure the patients with tumors who have received radical treatment, improve the quality of life of patients with advanced tumors, and prolong the survival of patients to achieve “survival with tumors” [15]
Summary
Lung cancer ranks first in the incidence and mortality of malignant tumors in China, accounting for 18% of newly diagnosed cases in 2018, and more than 690,000 people died as a result [1]. Lung cancer has a high morbidity and mortality among all malignancies in the world today [2]. It can be divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), the latter accounting for about 80–85% [3]. Surgical treatment is the radical cure for patients with early- and middle-stage NSCLC in the National Comprehensive Cancer Network (NCCN) guidelines. Due to the lack of typical clinical manifestations, early screening of lung cancer is difficult. Most of them have diagnosed at advanced stage and have lost the opportunity for surgery.
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