Efficacy of subsequent docetaxel +/− ramucirumab and S‐1 after nivolumab for patients with advanced non‐small cell lung cancer

Abstract

Background Cytotoxic chemotherapy for advanced non‐small cell lung cancer (NSCLC) as second‐line or subsequent treatment generally results in a poor treatment outcome. Several reports have indicated that subsequent cytotoxic chemotherapy in patients who have received immune checkpoint inhibitors (ICIs) might have relatively better efficacy. Methods The clinical data of advanced NSCLC patients treated with nivolumab during clinical practice at the National Cancer Center Hospital between 17 December 2015 and 31 August 2017 were consecutively reviewed, and the treatment outcomes of docetaxel‐based chemotherapy (docetaxel +/− ramucirumab) or S‐1 after nivolumab were analyzed. The results were then compared with those of advanced NSCLC patients treated with docetaxel or S‐1 but not ICIs during clinical practice between 17 December 2014 and 16 December 2015. Results Thirty patients were administered docetaxel‐based chemotherapy and 21 patients were administered S‐1 in any line after nivolumab. Twenty‐four patients were administered docetaxel‐based chemotherapy and 15 patients were administered S‐1 immediately after nivolumab. Sixty‐six patients were administered docetaxel and 23 patients were administered S‐1 without ICIs. The objective response rate, disease control rate, and median progression‐free survival duration were 28.6%, 53.6%, and 5.26 months for patients receiving docetaxel‐based chemotherapy or S‐1 immediately after nivolumab treatment; 24.3%, 51.4%, and 3.88 months for patients receiving docetaxel‐based chemotherapy or S‐1 in any line after nivolumab; and 16.4%, 56.7%, and 2.74 months, for patients receiving docetaxel or S‐1 without ICIs, respectively. Conclusion Subsequent cytotoxic chemotherapy, especially immediately after nivolumab, has better treatment efficacy than that of regimens without ICI pretreatment.

Previous Immune Checkpoint Inhibitor Treatment to Increase the Efficacy of Docetaxel and Ramucirumab Combination Chemotherapy

“…Tamura et al also indicated that the effectiveness of docetaxel with or without Figure 1. ramucirumab or S1 therapy after nivolumab might be enhanced (5,8), and our results are consistent with their findings.…”

Real-world effectiveness and safety of nivolumab in patients with non-small cell lung cancer: A multicenter retrospective observational study in Japan

“…DTX or DTX + RAM was also recently reported to achieve a higher response rate as a subsequent chemotherapy after nivolumab compared to that without prior nivolumab treatment [18,19]. In this study, DTX + RAM showed a preferable response rate in ORR among the common regimens.…”

Efficacy of S‐1 after pemetrexed in patients with non‐small cell lung cancer: A retrospective multi‐institutional analysis

“…Previous reports on S-1 monotherapy have been compared with the findings of this study (Table 3). 2,8,9,[12][13][14][15][16][17][18][19] Interestingly, in two studies on efficacy of S-1 with a registration period prior to 2009, S-1 showed higher ORR in adenocarcinoma or non-SQ than in squamous cell carcinoma. 13,14 PEM was probably not administered to the analyzed populations because the efficacy of PEM was not improved in clinical trials at the time.…”

“…It is still unknown whether ICIs improve the treatment efficacy of S-1. 18,19 Exploratory analysis on the predictive factor of S-1 after PEM suggested a longer period between last PEM administration and first S-1 administration. It might therefore be an option to avoid S-1 treatment immediately after PEM.…”