BackgroundSalvage chemotherapy after immune checkpoint inhibitor (ICI) treatment has been reported to increase the antitumor effect. There are also some reports that activation of vascular endothelial growth factor (VEGF) / its receptor (VEGFR) signal is one of the ICI resistant mechanism, and that combination therapy of VEGF / VEGFR inhibitor and ICI had synergistic effect. In ICI pretreated patients, docetaxel and ramucirumab combination therapy (DOC+RAM) may be more effective. In order to verify this hypothesis, the retrospective observation study was conducted. MethodsFrom June 2013 to July 2018, in 39 patients with advanced / recurrent non-small cell lung cancer who underwent DOC+RAM therapy at our hospital the efficacy and safety were analysed based on the presence (pre-ICI+) or absence (pre-ICI-) of ICI pretreatment history. ResultsOf the 39 patients treated with DOC+RAM, 18 (pre-ICI+: 46%) patients had been pretreated with ICI. The characteristics (pre-ICI+/ pre-ICI-) were as follows; median age was 67/65 years, median treatment line was 3/3, ECOG PS:0,1 was 94%/86%, 83%/48% were male, 72%/95% had adenocarcinoma, and 89%/67% were smokers, PD-L1status ≧50% was 6%/5%, 11%/38% had EGFR mutation. The ORRs for DOC+RAM in pre-ICI+ and pre-ICI- were 38.9% vs. 19.0%, respectively (p=0.29). Median progression free survival was 5.7 vs. 2.3 months (hazard ratio (HR), 0.36; 95% confidential interval [CI], 0.16-0.80). Median overall survival was 13.8 vs. 10.5 months (HR, 0.41; 95% [CI], 0.16-1.04). Because of adverse events, nine patients (50%) in pre-ICI+ group and two patients (9.5%) in pre-ICI- group discontinued DOC+RAM therapy. Adverse events such as fever (50%/38%), myalgia (39%/9.5%), arthritis (33%/4.8%), pleural effusion (22%/4.8%) and pneumonitis (17%/4.8%) tended to be more frequent in pre-ICI+ group. There were no grade 5 AEs. ConclusionsIn this study, statistically significant prolongation of PFS, the tendency of tumor regression improvement and OS prolongation achieved by DOC + RAM, and the concern of increased toxicity were shown in pre-ICI+ patients. Legal entity responsible for the studyDaijiro Harada. FundingHas not received any funding. DisclosureD. Harada: Honoraria (self), Research grant / Funding (institution): AstraZeneca K.K.; Research grant / Funding (institution): Novartis International AG; Research grant / Funding (institution): Kissei Pharmaceutical Co., Ltd; Research grant / Funding (institution): Takeda Pharmaceutical Company Limited.; Honoraria (self): Ono Pharmaceutical Co., Ltd.; Honoraria (self): Bristol-Myers Squibb Company; Honoraria (self): Kyowa Hakko Kirin Co., Ltd.; Honoraria (self): Eli Lilly and Company Nyse: LLY; Honoraria (self): MSD K.K. ; Honoraria (self): Taiho Pharmaceutical Co., Ltd.; Honoraria (self): Nippon Boehringer Ingelheim Co ., Ltd. T. Kozuki: Honoraria (self), Research grant / Funding (institution): Chugai Pharmaceutical Co., Ltd.; Honoraria (self), Research grant / Funding (institution): AstraZeneca K.K; Honoraria (self), Research grant / Funding (institution): Eli Lilly Japan K.K.; Honoraria (self): Taiho Pharmaceutical Co., Ltd.; Honoraria (self), Research grant / Funding (institution): Bristol-Myers K.K; Honoraria (self): Ono Pharmaceutical Co., Ltd.; Honoraria (self): MSD K.K; Honoraria (self), Research grant / Funding (institution): Pfizer; Honoraria (self): Kyowa Hakko Kirin Co., Ltd; Honoraria (self): Nippon Beohringer Ingelheim Co., Ltd.; Honoraria (self): Nippon-Kayaku Co.; Research grant / Funding (institution): Merck Serono. N. Nogami: Honoraria (self): Astellas Pharma; Honoraria (self): AstraZeneca; Honoraria (self): Ono Pharmaceutical; Honoraria (self): Taiho Pharmaceutical; Honoraria (self): Chugai Pharmaceutical; Honoraria (self): Eli Lilly; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Pfizer. All other authors have declared no conflicts of interest.
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