Local therapy with continued EGFR-TKIs as a treatment in lung adenocarcinomas which have acquired drug resistance

Objective To investigate the clinical efficacy of cryoablation and bronchial artery embolization combined with epithelial growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of lung adenocarcinoma after drug resistance progression. Methods The study retrospectively analyzed 32 patients with sensitive EGFR mutations and showed a clinical benefit from initial EGFR-TKI and then advanced in Emergency General Hospital from March 2012 to December 2018.These patients (T790M negative) received cryoablation and continued on the same EGFR-TKI.Then calculated PFS1: from initial EGFR TKIs to first disease progression, PFS2: from cryoablation to second progression, OS: overall survival, OS1: the overall survival after cryoablation. Results The mean PFS1 of 32 patients with advanced lung adenocarcinoma was (12.4±8.6) months.Among them, 14 patients were treated with bronchial artery embolization before cryoablation, and a total of 38 lesions were ablated.The mean PFS2 time was (6.7±2.9) months.The mean OS time was (31.5±13.5) months, in which OS1 was (15.5±7.6) months.Statistical analysis showed that there was a significant correlation between PFS1 and PFS2 with OS, and the time from cryoablation after the progress of targeted therapy was correlated with OS.A few of complications after bronchial artery embolization combined with cryoablation were pneumothorax and pulmonary hemorrhage, the symptoms could be gradually relieved after treatment. Conclusions This study shows that cryoablation combined with EGFR-TKIs can prolong the survival of patients after drug resistance progression and with less complications, and achieve clinical benefits. Key words: Adenocarcinoma; Cryosurgery; Epithelial growth factor receptor tyrosine-kinase inhibitors; Bronchial artery embolization; Progress