# Influence of Previous Therapy for Neutropenia Caused by Combination Therapy of Ramucirumab and Docetaxel

## TL;DR

This study shows that prior immune checkpoint inhibitor treatment reduces severe neutropenia in lung cancer patients receiving ramucirumab and docetaxel.

## Contribution

The novel finding is that prior ICI treatment reduces grade ≥ 3 neutropenia in RAM + DTX therapy for NSCLC, independent of cytotoxic pretreatment.

## Key findings

- Previous ICI treatment significantly reduced grade ≥ 3 neutropenia in RAM + DTX therapy for NSCLC.
- Prophylactic G-CSF administration was also associated with reduced neutropenia risk.
- The effect of ICI treatment on neutropenia was independent of prior cytotoxic chemotherapy.

## Abstract

Ramucirumab (RAM) + docetaxel (DTX) therapy is recommended as a second-line treatment for non-small cell lung cancer (NSCLC) and pretreatment with immune checkpoint inhibitors (ICIs) has been reported to improve the therapeutic efficacy of this therapy. Meanwhile, caution should be exercised for the development of febrile neutropenia during this treatment and preventing the onset of neutropenia while continuing the treatment is greatly important. This study found that previous treatment with ICIs reduced the incidence of grade ≥ 3 neutropenia after RAM + DTX therapy in patients with NSCLC, regardless of the influences of pretreatment with cytotoxic anticancer agents. A history of ICI treatment may have a similar influence on carcinomas other than NSCLC.

In the present study, the influence of previous immune checkpoint inhibitor (ICI) therapy with ramucirumab (RAM) + docetaxel (DTX) therapy on the occurrence of severe neutropenia in patients with non-small cell lung cancer (NSCLC) was evaluated, taking into account the influences of cytotoxic chemotherapy used in pretreatment. The study participants included patients who received a combination therapy of RAM and DTX as cancer chemotherapy for NSCLC. The influences of previous ICI treatment and pretreatment with cytotoxic anticancer agents on the development of grade ≥ 3 neutropenia were analysed. A total of 89 patients, including 50 with and 39 without a history of ICI treatment, were analysed. Kaplan-Meier curves showed a significant difference in the influence of previous ICI treatment on the development of grade ≥ 3 neutropenia (p = 0.006). Moreover, Cox regression analysis identified a history of ICI treatment and prophylactic administration of G-CSF as factors associated with the development of grade ≥ 3 neutropenia (p = 0.018 and p < 0.001, respectively). This study found that previous treatment with ICIs reduced the incidence of grade ≥ 3 neutropenia after RAM + DTX therapy in patients with NSCLC, regardless of the influences of pretreatment with cytotoxic anticancer agents.