目的:Ramucirumab(RAM)和多西他赛(DOC)是晚期非小细胞肺癌(NSCLC)一线治疗后常用的药物。因此,我们旨在阐明先前治疗后RAM和DOC的测序策略,包括免疫检查点抑制剂(ICI),单独的细胞毒性剂(CTx),贝伐单抗(BEV),和酪氨酸激酶抑制剂(TKI)。
方法:我们招募了接受了RAM和DOC的NSCLC患者,并比较了有和没有ICI,单纯CTx的组,BEV,还有TKI,分别。通过肿瘤对这种治疗的反应,患者进一步分为“完全缓解(CR)+部分缓解(PR),“稳定的疾病,\"和\"进行性疾病\"组,分别。我们比较了这些组的RAM和DOC疗效。
结果:总计,237名患者登记。在先前有ICI的组中,客观缓解率和疾病控制率显着高于没有先前ICI的组(分别为p=0.012和0.028),中位无进展生存期(PFS)也显著延长(p=0.027).单独使用和不使用CTx的组之间的PFS没有显着差异,BEV,还有TKI.多因素分析显示,既往ICI是改善PFS的独立因素。此外,与之前没有ICI的组相比,之前有CR+PR的ICI组显著延长PFS(p=0.013).
结论:RAM和DOC可以优选在ICI后给药,而不是单独在CTx后给药,BEV,或者TKI,and,此外,如果先前的ICI具有良好的肿瘤反应,则增强。
OBJECTIVE: Ramucirumab (RAM) and docetaxel (DOC) are commonly used after first-line therapy for advanced non-small cell lung cancer (NSCLC). Therefore, we aimed to elucidate sequencing strategies of RAM and DOC following prior treatments, including immune checkpoint inhibitor (ICI), cytotoxic agent (CTx) alone, bevacizumab (BEV), and tyrosine kinase inhibitor (TKI).
METHODS: We recruited patients with NSCLC who received RAM and DOC and compared the groups with and without prior ICI, CTx alone, 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: In total, 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 alone, BEV, and TKI. Multivariate analysis revealed that prior ICI was an independent factor associated with better PFS. Furthermore, the prior ICI group with CR + PR significantly prolonged PFS compared to the group without prior ICI (p = 0.013).
CONCLUSIONS: RAM and DOC may be preferably administered after ICI, rather than after CTx alone, BEV, or TKI, and, furthermore, enhanced if the prior ICI has a favorable tumor response.