Shortterm clinical efficacy and analysis of quality of life of anlotinib in thirdline and above treatment for advanced nonsmall cell lung cancer

doi:10.3760/cma.j.issn.1673-422X.2019.03.004

Abstract

Abstract: ObjectiveTo evaluate the shortterm efficacy, safety and impact on the quality of life of anlotinib in thirdline and above treatment for advanced nonsmall cell lung cancer (NSCLC) patients. MethodsAll the patients received alotinib 12 mg/d. One cycle was defined as 2 weeks ontreatment followed by 1 week offtreatment until disease progression or treatment intolerance. Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was used to assess tumor responses. Common Terminology Criteria for Adverse Events (CTCAE) 4.02 was used to assess the adverse events. The European Organization for Research on Treatment of Cancer (EORTC) QLQC30 and QLQLC13 were used to assess quality of life. ResultsAmong 27 patients in study, no complete response (CR) was found, 2 patients (7.4%) achieved partial response (PR), 16 patients (59.3%) achieved stable disease (SD), 9 patients (33.3%) achieved progressive disease (PD), objective response rate (ORR) was 7.4%, and disease control rate (DCR) was 66.7%. The scores of physical functioning (76.00±10.55 vs. 64.44±11.59), emotional functioning (81.67±8.71 vs. 76.11±6.71) and global health status (48.87±7.97 vs. 40.56±12.49) of the QLQC30 scale after treatment were higher than those before treatment, with statistically significant differences (t=-4.516, P<0.001; t=-2.646, P=0.019; t=-3.872, P=0.002). Fatigue (50.37±8.95 vs. 40.74±13.86), nausea and vomiting (26.54±16.18 vs. 14.20±11.97), loss of appetite ［M(QR): 33.33(33.33) vs. 33(33.33)］ were better than before (t=-2.476, P=0.027; t=-5.036, P＜0.001; Z=-2.923, P=0.003); pain (28.88±14.23 vs. 33.33±13.60) and dyspnea ［33.33(33.33) vs. 33.33(66.67)］ scores were lower than before (t=3.674, P=0.003; Z=-3.266, P=0.001). The scores of cough (24.44±19.12 vs. 45.24±20.34), shortness of breath ［11.11(22.22) vs. 33.33(22.22)］ and chest pain ［0.00(33.33) vs. 33.33(33.33)］ in the QLQLC13 scale after treatment were lower than those before treatment, with statistically significant differences (t=4.000, P=0.001; Z=-4.125, P＜0.001; Z=-1.890, P=0.034); the scores of sore mouth or tongue ［0.00(33.33) vs. 0.00(0.00)］ and hands and feet tingling ［33.33(33.33) vs. 0.00(0.00)］ were higher than before (Z=-2.000, P=0.046; Z=-2.264, P=0.024). Common adverse reactions included hypertension, fatigue, elevated thyroid stimulating hormone, proteinuria, handfoot syndrome, oral mucositis, hemoptysis, etc, mainly grade 12, and they were all improved after the treatments. ConclusionAnlotinib as a thirdline and further therapy is positive effected and well tolerated. It can alleviate the clinical symptoms and significantly improve the quality of life of NSCLC patients.

Key words: Carcinoma, non-small-cell lung, Receptors, vascular endothelial growth factor, Quality of life, Anlotinib

Liu Nan, Wu Xiuwei, Li Fanfan, Wang Nianfei, Zhang Mingjun, Sun Tong, Chen Zhendong. Shortterm clinical efficacy and analysis of quality of life of anlotinib in thirdline and above treatment for advanced nonsmall cell lung cancer[J]. Journal of International Oncology, 2019, 46(3): 147-152.

References

［1］ Han B, Li K, Wang Q, et al. Effect of anlotinib as a thirdline or further treatment on overall survival of patients with advanced nonsmall cell lung cancer: the ALTER 0303 phase 3 randomized clinical trial［J］. JAMA Oncol, 2018, 4(11): 15691575. DOI: 10.1001/jamaoncol.2018.3039. ［2］ Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1)［J］. Eur J Cancer, 2009, 45(2): 228247. DOI: 10.1016/j.ejca.2008.10.026. ［3］ Bergman B, Aaronson NK, Ahmedzai S, et al. The EORTC QLQLC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQC30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life［J］. Eur J Cancer, 1994, 30A(5): 635642. ［4］ Shi J, Han B, Li K, et al. Subgroup analysis of elderly patients (pts) in ALTER0303: anlotinib hydrochloride as 3rdline and further line treatment in refractory advanced NSCLC pts from a randomized, doubleblind, placebocontrolled phase Ⅲ ALTER0303 trial［J］. J Clin Oncol, 2018, 36(15_suppl): e21181. DOI: 10.1200/JCO.2018.36.15_suppl.e21181. ［5］ Edeline J, Palmer D, Blanc JF, et al. mRECIST for systemic therapies: more evidence is required before recommendations can be made［J］. J Hepatol, 2017, 67(1): 195. DOI: 10.1016/j.jhep.2017.02.033. ［6］ Kamba T, McDonald DM. Mechanisms of adverse effects of antiVEGF therapy for cancer［J］. Br J Cancer, 2007, 96(12): 17881795. DOI: 10.1038/sj.bjc.6603813. ［7］ Han B, Li K, Wang Q, et al. Efficiency of anlotinib as 3rd line treatment in patients with different EGFR gene status, an exploratory subgroup analysis of ALTER0303 trial［J］. J Thorac Oncol, 2017, 12(11 suppl 2): S2275. DOI: https://doi.org/10.1016/j.jtho.2017.09.1632. ［8］ Cheng Y, Han B, Li K, et al. Subgroup analysis of histology in ALTER0303: anlotinib hydrochloride as 3rd line and further line treatment in refractory advanced NSCLC patients (pts)［J］. J Clin Oncol, 2018, 36(15_suppl): 9080. DOI: 10.1200/JCO.2018.36.15_suppl.9080. ［9］ Shen G, Zheng F, Ren D, et al. Anlotinib: a novel multitargeting tyrosine kinase inhibitor in clinical development［J］. J Hematol Oncol, 2018, 11(1): 120. DOI: 10.1186/s1304501806647.

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