Immunotherapy Combination Improves Survival in Advanced Non-Small Cell Lung Cancer

An immunotherapy combination of an immune checkpoint inhibitor plus ramucirumab may improve survival among patients with advanced non-small cell lung cancer (NSCLC), according to a study presented at the American Society of Clinical Oncology (ASCO) annual meeting.

The randomized phase 2 trial known as S1800A, led by researchers from Cedars-Sinai Cancer, was part of Lung-MAP, a precision medicine trial supported by the National Cancer Institute. The investigators noted that patients with advanced NSCLC have limited treatment options.

“This clinical trial shows promise in extending the lives of patients who have lung cancer that has become resistant to immunotherapy treatments,” Karen L. Reckamp, MD, director of Medical Oncology at Cedars-Sinai Cancer, associate director of Clinical Research at Cedars-Sinai and lead author of the ASCO abstract, said in a press release. “This is a game changer for the field, and more importantly, for the patients who may benefit from the treatment.”

The trial enrolled patients with recurrent NSCLC previously treated with immune checkpoint inhibitors. Half of the patients were randomized to standard of care—either chemotherapy alone or chemotherapy plus ramucirumab, which is an anti-angiogenesis medication that blocks the action of an enzyme vital in the formation of blood vessels, thereby weakening the tumor by depriving it of nutrients. The other half of the patients were administered the immune checkpoint inhibitor plus ramucirumab immunotherapy combination.

Patients in the immunotherapy cohort had a median overall survival of 14.5 months compared with 11.6 months for patients in the standard of care cohort.

Further, two-thirds of patients in the standard of care cohort elected to receive a combination of chemotherapy and ramucirumab instead of chemotherapy alone, which the investigators said is the best standard of care treatment.

The investigators found no significant differences in progression-free survival and overall response between patients in the standard of care cohort and the immunotherapy cohort.

“There were patients receiving the combination therapy who had a longer duration of response than those on standard of care,” Reckamp said in the release. “We have seen this pattern in prior immunotherapy trials where overall survival measures the benefit better than progression-free survival or response rate.”

Notably, the combination therapy allowed patients to avoid chemotherapy and its subsequent adverse effects (AEs). The investigators found that 40% of patients in the combination therapy cohort experienced significant treatment-related AEs compared with 60% of patients in the standard of care cohort.

This trial is the first in the second-line setting using the Lung-MAP platform without a chemotherapy backbone to show a potential survival benefit versus standard of care regimens, including docetaxel and ramucirumab, according to the investigators.

They added that the results merit further investigation and they are planning a phase 3 trial.

“These findings offer a potential solution that could change the standard of care for these patients and provide better outcomes for all patients in the future,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, in a press release. “Clinical advances like this accelerate progress and move the needle forward for the broader field of cancer research.”

Reference

ASCO22: Lung cancer therapy could help patients live longer. Cedars-Sinai Medical Center. News release. June 4, 2022. https://www.eurekalert.org/news-releases/954951