BACKGROUND: Chemotherapy plus immune-checkpoint inhibitor (CTx+ICI) therapy has become the preferred 1st line treatment in patients with metastatic NSCLC without oncogenic driven mutations. However, the optimal subsequent 2nd line treatment is not defined and several alternatives exist. The purpose of this analysis was to evaluate the efficacy of 2nd line docetaxel plus ramucirumab (D+R) initiated after failure of 1st line CTx+ICI. METHODS: Retrospective data were collected during routine care from German thoracic oncology centers. Only patients who had received at least one course of 2nd line D+R were included. ORR, PFS, OS and numbers of courses of D+R were investigated with PFS after initiation of D+R being the primary endpoint. RESULTS: Seventy-seven patients met the inclusion criteria. 2nd line treatment with D+R achieved an ORR and DCR of 32.5% and 62.4%, respectively. Median PFS for 2nd line therapy was 3.9 months with a DOR of 6.4 months. Median OS of 15.5 and 7.5 months were observed from the start of 1st line therapy and 2nd line treatment, respectively. No unexpected toxicities occurred. Presence of KRAS mutations was associated with significantly worse median PFS to D+R (2.8 vs. 4.5 months in wild-type cases; P=0.021) and was an independent predictor of inferior PFS in multivariate analysis. CONCLUSIONS: D+R is an effective and safe 2nd line treatment after failure of 1st line CTx+ICI irrespective of NSCLC histology. However, patients with a KRAS mutation did not benefit from D+R in terms of PFS and will require further investigations.
- Brueckl, W. M.
- Reck, M.
- Rittmeyer, A.
- Kollmeier, J.
- Wesseler, C.
- Wiest, G. H.
- Christopoulos, P.
- Stenzinger, A.
- Tufman, A.
- Hoffknecht, P.
- Ulm, B.
- Reich, F.
- Ficker, J. H.
- Laack, E.
Keywords
- Lung cancer
- angiogenesis inhibitor
- immune-checkpoint inhibitor (ICI)
- palliative treatment
- ramucirumab
- (available at https://dx.doi.org/10.21037/tlcr-21-197). Albrecht Stenzinger serves
- as an unpaid editorial board member of Translational Lung Cancer Research from Sep
- 2019 to Sep 2021. The following authors received honoraria for lectures,
- presentation, speakers bureaus, manuscript writing or educational events: WMB from
- AstraZeneca, Boehringer, Novartis, MSD, BMS, Roche and Lilly
- MR from Amgen,
- AstraZeneca, BMS, Boehringer, Lilly, Minde, Merck, MSD, Novartis, Pfizer and Roche
- AR from AbbVIe, AstraZeneca, BMS, Boehringer, Lilly, MSD, Novartis, Pfizer and
- Roche
- CW from Boehringer, Lilly, MSD, Roche, AstraZeneca, BMS, Sanofi Aventis and
- Takeda
- GHW from Boehringer, Lilly, MSD, Roche, AstraZeneca, BMS, Sanofi Aventis,
- Takeda, Glaxo and Berlin Chemie
- PC from Roche, Takeda, AstraZeneca and Novartis
- AS
- from Aignostics, Bayer, Thermo Fisher, Illumina, AstraZeneca, Novartis, Pfizer,
- Roche, Seattle Genetics, MSD, BMS, Takeda and Lilly
- AT from GSK, Novartis, Amgen,
- BMS, MSD, Lilly, Pfizer, Boehringer, Roche, Takeda and Celgene
- JHF from
- AstraZeneca, Boehringer, Novartis, MSD, BMS and Roche. The following authors
- received support for attending meetings and/or travel: WMB from Boehringer,
- AstraZeneca and Roche
- CW from Boehringer, MSD, Roche, AstraZeneca and BMS
- GW from
- Boehringer, MSD, Roche, AstraZeneca and Berlin Chemie
- PC from AstraZeneca, Takeda,
- Novartis and Lilly
- AT from GSK, Novartis, Amgen, MSD, BMS, Lilly, Pfizer,
- Boehringer, Roche, Takeda and Celgene
- JHF from Boehringer and AstraZeneca. The
- following authors participated on a data safety monitoring board or an advisory
- board: WMB on AstraZeneca, Boehringer, Novartis, MSD, Lilly, BMS and Roche
- JK on
- Roche, Boehringer, BMS, Merck, Amgen, Takeda and Lilly (all outside the submitted
- work and all without receiving any personal fees
- CW on Boehringer, MSD, Roche,
- AstraZeneca and MBS
- GHW on Boehringer, MSD, Roche, AstraZeneca and BMS
- PC on
- Pfizer, Chugai, Boehringer and Roche
- AT on GSK, Novartis, Amgen, MSD, BMS, Lilly,
- Pfizer, Boehringer, Roche, Takeda, Celgene and AIO Leadership Group
- PH on Lilly,
- MSD, BMS, AstraZeneca, Takeda, Roche, Boehringer and Pfizer
- JHF on AstraZenca. The
- following authors receipt equipment, materials, drugs, medical writing, gifts or
- other services: WMB from Boehringer (for medical writing)
- JHF from Novartis (for
- medical writing)
- the following authors received consulting fees: AR from AbbVie,
- AstraZeneca, BMS, Boehringer, Lilly, MSD, Novartis, Pfizer and Roche. The following
- authors received grants or contracts form any entity: PC from Roche, Takeda,
- AstraZeneca and Novartis (all research grants to the institution
- AT from
- AstraZeneca (research grant). The other authors have no conflicts of interest to
- declare.
