Efficacy of Docetaxel Plus Ramucirumab as Palliative Third-Line Therapy Following Second-Line Immune-Checkpoint-Inhibitor Treatment in Patients With Non-Small-Cell Lung Cancer Stage IV.
Wolfgang M Brueckl, Martin Reck, Achim Rittmeyer, Jens Kollmeier, Claas Wesseler, Gunther H Wiest, Petros Christopoulos, Amanda Tufman, Petra Hoffknecht, Bernhard Ulm, Fabian Reich, Joachim H Ficker, Eckart Laack
Author Information
Wolfgang M Brueckl: Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany. ORCID
Martin Reck: LungenClinic Grosshansdorf, Großhansdorf, Germany.
Achim Rittmeyer: Ambulanz für pneumologische Onkologie, Lungenfachklinik Immenhausen, Kassel, Germany.
Jens Kollmeier: Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany.
Amanda Tufman: Medizinische Klinik und Poliklinik V (Pneumologie), Klinikum der Universität München, Munich, Germany.
Petra Hoffknecht: Zentrum Klinik für Thoraxonkologie im Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany.
Bernhard Ulm: Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany.
Fabian Reich: Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany.
Joachim H Ficker: Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany.
BACKGROUND: Antiangiogenic agents have been shown to stimulate the immune system and cause synergistic effects with chemotherapy. Effects might be even stronger after immune-checkpoint-inhibitor (ICI) therapy. The purpose of this analysis was to evaluate the efficacy of ramucirumab plus docetaxel (R + D) as third-line treatment after failure of a first-line platinum-based chemotherapy and a second-line ICI treatment in patients with non-small-cell lung cancer (NSCLC) stage IV. METHODS: Retrospective data were collected from 9 German thoracic oncology centers. Only patients who had received at least 1 cycle of third-line R + D were included. The numbers of cycles, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were investigated. RESULTS: Sixty-seven patients met the criteria for inclusion. Third-line treatment with R + D achieved an ORR of 36% and a disease control rate (DCR) of 69%. Median PFS for third-line therapy was 6.8 months with a duration of response (DOR) of 10.2 months. A median OS of 29 months was observed from the start of first-line therapy with a median OS of 11.0 months from the start of third-line treatment. No unexpected toxicities occurred. CONCLUSION: R + D is a highly effective and safe third-line treatment after failure of second-line programmed cell death protein 1/programmed cell death-ligand 1 (PD1/PD-L1)-derived ICI therapy irrespective of NSCLC histology. As there may be synergistic effects of second- and third-line treatments, this sequence is a very suitable option for patients not treated with first-line ICI. In addition, R + D should continue to be investigated as a second-line treatment option after failure of chemotherapy plus ICI in the palliative first-line treatment.
