Improved efficacy of ramucirumab plus docetaxel after nivolumab failure in previously treated non‐small cell lung cancer patients

Abstract

Background It is unclear whether the chemotherapy response improves after exposure to immunotherapy. Antiangiogenic agents have been shown to stimulate the immune system and cause synergistic effects that stimulate tumor shrinkage. We conducted a retrospective study to evaluate improvement of the efficacy of ramucirumab plus docetaxel after the failure of nivolumab as a PD‐1 inhibitor. Methods From February 2016 to December 2017, 152 patients with non‐small cell lung cancer (NSCLC) administered nivolumab in our institution were identified. We reviewed the records of 20 NSCLC patients administered ramucirumab plus docetaxel after nivolumab failure. The overall response rate (ORR), progression‐free survival (PFS), and overall survival (OS) were investigated. Pegylated granulocyte colony‐stimulating factor was prophylactically administered to 18 patients (90%) after the administration of ramucirumab plus docetaxel. Results The median age of the patients was 70 (range: 55–77) years. Twelve patients were male and eight were female. The histology was adenocarcinoma in 16 patients, squamous cell carcinoma in three, and other in one. The ORR of ramucirumab plus docetaxel was 60%, and the PFS and OS were 169 and 343 days, respectively. Among the 20 patients, 12 achieved a partial response, giving an ORR of 60.0%. Six patients had stable disease and two had progressive disease. The disease control rate was 90%. Gastrointestinal adverse events were frequently observed in 19 patients. Conclusions Ramucirumab plus docetaxel achieved a higher response rate when administered immediately after nivolumab failure compared to regimens without prior nivolumab administration.

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.…”

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

“…Shiono et al showed that, after nivolumab treatment, DOC+RAM therapy is highly effective (6). The ORR of DOC+RAM was reported to be 60%, and the PFS and OS were 169 and 343 days, respectively.…”

Treatment options beyond immunotherapy in patients with wild-type lung adenocarcinoma: a Delphi consensus

“…Several studies have suggested that treatment with immunotherapy does not condition the efficacy of subsequent chemotherapy. On the contrary, these studies seem to suggest an increase in the efficacy of chemotherapy [40][41][42][43][44], particularly when combined with anti-angiogenic agents [45][46][47], when administered after treatment with immunotherapy. Synergistic activity in both preclinical [48,49] and clinical models [21,22,25,26] support a hypothesis of a possible chemosensitization after prior exposure to immunotherapy.…”