Outcomes of concurrent versus sequential icotinib therapy and chemotherapy in advanced non-small cell lung cancer with sensitive EGFR mutations.

To explore a better treatment strategy for patients with advanced non-small cell lung cancer harboring sensitive epidermal growth factor receptor mutations, a total of 271 patients were retrospectively analyzed. The patients were divided into two groups: the combination group (58 cases), which received concurrent icotinib, pemetrexed, and platinum treatment, and the sequential group (213 cases), which received the sequential pemetrexed and platinum therapy, followed by icotinib treatment. The primary end points were progression-free survival (PFS) and PFS on the subsequent line of therapy (PFS2). PFS in the combination group was significantly higher compared with that in the sequential group (16.89 months vs. 9.90 months; p < 0.001). PFS in the combination group was also significantly higher than PFS2 in the sequential group (16.89 months vs. 14.05 months; p = 0.009). The overall survival (OS) of the patients was 33.22 months (95% confidence interval (CI): 26.99-37.01) in the combination group and 26.47 months (95% CI: 25.05-26.95) in the sequential group (p < 0.001). The combination group's objective response rate was superior to that of the sequential group (79.31% vs. 52.11%; p < 0.001). Propensity score matching also revealed that icotinib therapy combined with chemotherapy extended the PFS, PFS2, and OS of the patients (p < 0.0001, p = 0.003, and p = 0.001, respectively). The combination group's objective response rate was also better compared with the sequential group (79.31% vs. 51.72%; p = 0.001). In conclusion, our study demonstrated icotinib combined with chemotherapy can improve survival efficacy better than the separated two-line therapy. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? For advanced non-small cell lung cancer (NSCLC) harboring activating EGFR mutants, EGFR-tyrosine kinase inhibitors (TKIs) are the standard first-line treatment. Unfortunately, most patients with NSCLC harboring EGFR mutations acquire EGFR-TKI resistance after EGFR-TKI treatment for about 10-14 months. Studies have indicated that chemotherapy plus EGFR-TKIs may have combined effects on the growth of NSCLC cells. However, until now, there has been no study comparing the concurrent and sequential EGFR-TKIs plus chemotherapy. WHAT QUESTION DID THIS STUDY ADDRESS? We retrospectively analyzed the efficacy and safety of concurrent versus sequential icotinib and chemotherapy in untreated NSCLC with sensitive EGFR mutations. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? In the patients with NSCLC with sensitive EGFR mutations, the first-line pemetrexed plus platinum combined with icotinib better improved PFS, PFS2, and objective response rate compared with first-line icotinib and second-line pemetrexed plus platinum. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? The results of this paper provide guidance for the strategy choice in the treatment of patients with NSCLC.

Metastatic lymph node ratio and Lauren classification are independent prognostic markers for survival rates of patients with gastric cancer.

The long-term prognosis for patients with gastric cancer (GC) following radical resection remains poor. It is important to identify prognostic markers to predict survival. In the present retrospective study, the association between the metastatic lymph node ratio (rN) and the Lauren classification on predicting overall survival (OS) was investigated. Furthermore, a subgroup analysis was performed on the Lauren classification, using rN score as an independent prognostic marker. In total, 261 pathologically confirmed patients with GC were retrospectively reviewed. Kaplan-Meier curves and Cox's proportional hazards modeling were applied to analyze the OS of patients, and were utilized in the subgroup analysis. Receiver operating characteristic (ROC) curves were used to compare the accuracy of prognosis between the rN score and lymph node staging (N stage). The χ2 test was used to analyze the association between the rN score and Lauren classification. Univariate survival and multivariate analysis demonstrated that the rN score and Lauren classification were significant prognostic markers for patients with GC. The ROC analysis confirmed that the rN score was more effective than N staging for OS prediction. Subgroup analysis indicated that rN was more accurate at predicting OS time in patients with diffuse type GC. The rN score and the Lauren classification were independent prognostic factors for the OS of patients with GC following radical resection, and the rN score was more accurate than the N stage for predicting the prognosis. Overall, the rN may be suitable as an independent predictor for OS in patients with diffuse type GC.

Prognostic significance of neutrophil-lymphocyteratio/platelet-lymphocyteratioin lung cancers: a meta-analysis.

SETTING: For now, hematological markers of inflammatory response have emerged as prognostic factors for patients with cancer. Many articles have confirm that neutrophil to lymphocyte ratio(NLR) and platelet-lymphocyte ratio (PLR) are relate with poor prognosis in various types of tumors. OBJECTIVE: To investigate the association between NLR/PLR and progression free survival (PFS), overall survival (OS) and clinicopathologic parameters in lung cancer patients. DESIGN: We performed relevant searches in PubMed database, Google Scholar, Springer Link. We included retrospective cohort studies that reported hazard ratios with 95% confidence intervals for the NLR or PLR and PFS or OS. RESULTS: Both high NLR (P < 0.00001) and high PLR (P = 0.01) were significantly predictive of poorer OS. It also demonstrated that elevated NLR predicted poorer PFS (P = 0.0002). High NLR was significantly associated with deeper Invasive of tumor, (P = 0.006) extensive lymph nodetastasis(N2-3) (P = 0.01), poor differentiation (P = 0.0002) and vascular invasion(P = 0.002).There was no evidence of publication bias. Subgroup analysis indicated that little evidence of heterogeneity. However, PLR has no prognostic significance for SCLC. CONCLUSIONS: We provides further evidence in support of elevated NLR and PLR were predictors of poor OS and PFS in patients with lung cancer. Given this, NLR and PLR may be markers to report treatment outcomes.