Almonertinib/Pemetrexed/Carboplatin in EGFR T790M+ Advanced Lung Cancer

Exclusion Criteria

• •1. Patients who have received three generations of EGFR-TKI treatment;
• •2. Patients with mixed small cell lung cancer components;
• •3. Patients with advanced or metastatic disease who have received palliative chemotherapy, or patients with tumor recurrence and metastasis within 6 months after radical surgery with adjuvant chemotherapy;
• •4. Patients with symptomatic brain metastasis, meningeal metastasis or spinal cord compression;
• •5. Patients with previous diagnosis of interstitial pneumonia;
• •6. Uncontrolled hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, despite the best medication);
• •7. with severe cardiovascular disease: Ⅱ magnitude of myocardial ischemia and myocardial infarction, poor control of cardiac arrhythmias (including QTc interphase male 450, female 470 ms or ms or higher);According to NYHA standard, Ⅲ \~ Ⅳ cardiac insufficiency, or heart colour to exceed revealed left ventricular ejection fraction (LVEF) \< 50%;
• •8. abnormal coagulation function (INR \>1.5 or prothrombin time (PT) \> ULN+4 seconds or APTT \> 1.5uln), bleeding tendency or receiving thrombolytic or anticoagulant therapy; Note: Under the condition that the international standard ratio of prothrombin time (INR) ≤1.5, low-dose heparin (daily dosage for adults ranges from 66,000 to 12,000 U) or low-dose aspirin (daily dosage ≤100 mg) is allowed for preventive purposes.
• •9. Peripheral neuropathy ≥CTCAE 2 is present, except for trauma;
• •10. Respiratory syndrome (≥CTCAE level 2 dyspnea), uncontrolled serous cavity effusion (including pleural effusion, ascites and pericardial effusion);
• •11. A wound or fracture that has not been healed for a long time;
• •12. Severe infections requiring systemic antibiotics;
• •13. Decompensated diabetes mellitus or other contraindications of high-dose glucocorticoid therapy;
• •14. Active hepatitis C and/or hepatitis B infection (hepatitis B: HBsAg positive with HBV DNA≥500IU/mL;Hepatitis C: HCV RNA positive);
• •15. Factors that significantly affect oral drug absorption, such as inability to swallow, chronic diarrhea, and intestinal obstruction;
• •16. Had major surgery or severe traumatic injury, fracture or ulcer within the first 4 weeks;
• •17. Any contraindications for platinum (carboplatin) and cytotoxic drug (Pemetrexed) treatment;
• •18. Other conditions deemed inappropriate by the researcher for inclusion in the study.