Efficacy of Endostatin Combined with EGFR-TKIs in the Treatment of Malignant Pleural Effusion in EGFR-positive Advanced Lung Adenocarcinoma

Abstract

Objective: To investigate the clinical efficacy of Endostatin (recomibinant human endostatin) combined with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of malignant pleural effusion (MPE) in advanced lung adenocarcinoma with positive EGFR mutation. Methods: 80 patients with malignant pleural effusion of lung adenocarcinoma with EGFR mutation-positive who were admitted to our hospital from October 2017 to October 2021 were enrolled in the study. According to the therapy methods, they were divided into an observation group and a control group, with 40 cases in each group. The control group was treated with EGFR-TKI; and the observation group was treated with EGFR-TKI combined with Endostatin (60 mg Intrapleural perfusion on the 1st day, the 4th day, twice a week, for 2 weeks). Adverse reactions, quality of life (QOL), short-term curative efficacy, serum oncology markers, and standard of HIF-1α and VEGF in pleural effusion were evaluated after two weeks in the last treatment, and Progression-free survival (PFS) and overall survival (OS) were follow-up. Results: The ORR and DCR in the observation group was higher the control group (72.5% vs.35.0%, 90.0% vs.65.0%, P<0.05). Total improvement rate of KPS score in the observation group was higher than the control group (87.5%vs.57.5%, P<0.05). Serum Cyfra21-1,CEA and CA125 in observation group was lower than the control group (P<0.05),and HIF-1α and VEGF in hydrothorax in observation group was lower than the control group (P<0.05). Adverse effects included leukopenia, thrombocytopenia, hemoglobin reduction, nausea and vomiting, and diarrhea, and there was no significant difference between the two groups (P>0.05). The median PFS in the observation group was greater than the control group (15 months vs.10 months, P<0.05). The median OS in the observation group was higher than that in the control group (20 months vs. 17 months, P<0.05). Conclusion: Intrathoracic perfusion of endostatin combined with EGFR-TKIs and Zilongjin in the treatment of adenocarcinoma with positive EGFR mutation of NSCLC combined with massive MPE can improve the short-term curative effect, lengthen the PFS and OS, and improve the QOL without increasing the toxic and side effects. It is worthy of further clinical promotion.