Docetaxel and Ramucirumab as Subsequent Treatment After First-Line Immunotherapy-Based Treatment for Metastatic Non-Small-Cell Lung Cancer: A Retrospective Study and Literature Review

TL;DR

This study shows that the combination of docetaxel and ramucirumab works well as a second-line treatment for lung cancer patients who previously received immunotherapy.

Contribution

The study provides real-world evidence of docetaxel/ramucirumab efficacy after immunotherapy failure in metastatic NSCLC.

Findings

Median progression-free survival was 5.8 months and overall survival was 11.1 months.

Patients with ≥6 months of prior immunotherapy had better outcomes in survival.

The regimen had a 42% response rate and 76% disease control rate.

Abstract

The combination of docetaxel and ramucirumab is a standard second-line treatment for patients with advanced metastatic non-small-cell lung cancer (NSCLC); however, evidence supporting this regimen comes from the REVEL trial conducted before the introduction of immune checkpoint inhibitors (ICIs) in clinical practice. ICIs have now been approved as first-line therapy for metastatic NSCLC, raising the question of the efficacy of this combination after ICI failure. In our study, we report on the outcomes of 55 patients who received docetaxel/ramucirumab after progression on ICI-based therapy. Median progression-free survival (PFS) and overall survival (OS) were 5.8, and 11.1 months, respectively, whilst objective response rate and disease control rate were 42% and 76%, respectively. Patients who received ICI-based therapy lasting for ≥6 months had numerically better median PFS and a statistically significant increase in OS compared to those who were treated with ICI-based therapy for <6 months. Our results compare favorably with the REVEL study, providing further support for the use of this combination after ICIs.

Background: A combination of docetaxel and ramucirumab represents a standard of care in second-line treatment for patients with advanced NSCLC. Evidence of the regimen’s efficacy is based on the results of the REVEL trial conducted in the pre-immunotherapy (immune checkpoint inhibitors–ICIs) era. Given the lack of randomized trials after the use of ICIs in front-line therapy, a question remains regarding the impact of the combination when disease progresses after ICI-based therapy. Methods: From 1 January 2018 to 31 December 2024, 55 patients from three oncology centers who had documented progression on ICI-based therapy subsequently received docetaxel/ramucirumab, and we reviewed their outcomes. Results: The studied group’s median progression-free survival (PFS) was 5.8 months, while the median overall survival (OS) was 11.1 months. The objective response rate (ORR) and disease control rate (DCR) were 42% and 76%, respectively. Patients who had received ICI-based therapy for ≥6 months had a numerically better median PFS and statistically significant OS compared to those who had experienced progression on ICI-based therapy in <6 months. Regarding adverse events (AEs), 92.7% of patients experienced Grade 1–2 AEs, whereas 54.5% experienced Grade ≥ 3 AEs. One death due to GI bleeding was also recorded. Conclusion: Docetaxel/ramucirumab is an acceptable regimen for patients progressing on first-line ICI-based therapies. Our results are in concordance with the REVEL study and other retrospective studies of this combination after ICIs.

Figures