Impact of prior immune checkpoint inhibitor and its tumor response on ramucirumab and docetaxel for advanced non-small cell lung cancer: a multicenter retrospective cohort study

Abstract Purpose Ramucirumab (RAM) and docetaxel (DOC) are commonly used after first-line therapy including immune checkpoint inhibitor (ICI) for advanced non-small cell lung cancer (NSCLC). Therefore, it is important to evaluate sequential strategies of RAM and DOC following various type of treatments; however, those remain unknown. We aimed to elucidate the impact of front-line treatments including ICI, cytotoxic agent (CTx), bevacizumab (BEV), and tyrosine kinase inhibitor (TKI) on RAM and DOC efficacy. Methods We recruited patients with NSCLC who received RAM and DOC and compared the groups with and without prior ICI, CTx, BEV, and TKI, respectively. By tumor response to such treatments, the patients were further classified into “complete response (CR) + partial response (PR),” “stable disease.” and “progressive disease”groups, respectively. We compared RAM and DOC efficacy among these groups. Results 237 patients were registered. In the group with prior ICI, the objective response rate and disease control rate were significantly higher than those without prior ICI (p = 0.012 and 0.028, respectively), and the median progression-free survival (PFS) was also significantly longer (p = 0.027). There were no significant differences in PFS between the groups with and without CTx, BEV, and TKI. Multivariate analysis revealed that prior ICI was an independent factor associated with better PFS. Futheremore, the prior ICI group showing CR + PR significantly prolonged PFS compared to the group without prior ICI (p = 0.013). Conclusion RAM and DOC efficacy may be enhanced when ICIs are administered in the prior line and especially show good tumor response.