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Efficacy of ramucirumab and subsequent nivolumab therapy in patients with advanced gastric cancer: A retrospective
Masaaki Saito1, Koichi Suzuki1, Sawako Tamaki1
1Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
Abstract:
Nivolumab monotherapy is a standard treatment of metastatic gastric cancer, and this type of cancer involves vascular endothelial growth factor (VEGF) signaling in the tumor immunological environment. The subgroup analysis of the ATTRACTION-2 trial revealed that prior treatment with ramucirumab (RAM), a VEGF inhibitor, affected the therapeutic effect of nivolumab. The present retrospective study aimed to review patients with metastatic gastric cancer who were treated with paclitaxel (PTX) and RAM followed by nivolumab. A total of 29 patients with metastatic gastric cancer were treated with PTX + RAM as second-line treatment, followed by nivolumab monotherapy as third-line treatment. The therapeutic efficacy of nivolumab was compared in 13 patients with progression-free survival (PFS) of <5 months and 16 patients with PFS ≥5 months after PTX + RAM therapy. The present study included 22 male and seven female patients, with a median age of 68 years (range, 45-82 years). Human epidermal growth factor receptor 2 positivity was observed in six patients. The disease control rate was 62.1%. The PFS and overall survival (OS) were 4.4 and 11.9 months, respectively. Patients with PFS ≥5 months after PTX + RAM therapy showed better outcome in both PFS (5.3 months vs. 2.8 months, P=0.039) and OS (6.9 months vs. 15.2 months, P=0.066) after nivolumab treatment than patients with PFS of <5 months after PTX + RAM therapy. However, no significant relationship was observed between the outcome of first-line treatment and nivolumab. The therapeutic effect of nivolumab was associated with prior PTX + RAM treatment in advanced gastric cancer.
Insights
Prior treatment with paclitaxel and ramucirumab (PTX + RAM) impacts nivolumab efficacy in metastatic gastric cancer. Patients with longer progression-free survival (PFS) after PTX + RAM showed improved outcomes with subsequent nivolumab therapy.
Area of Science:
- Oncology
- Immunotherapy
- Gastrointestinal Cancers
Background:
- Nivolumab is a standard treatment for metastatic gastric cancer.
- Vascular endothelial growth factor (VEGF) signaling is implicated in the tumor microenvironment of gastric cancer.
- Prior ramucirumab (RAM) treatment, a VEGF inhibitor, may influence nivolumab's effectiveness.
Purpose of the Study:
- To evaluate the efficacy of nivolumab in metastatic gastric cancer patients previously treated with paclitaxel (PTX) and RAM.
- To determine if the duration of progression-free survival (PFS) after PTX + RAM therapy predicts response to subsequent nivolumab treatment.
Main Methods:
- Retrospective study of 29 metastatic gastric cancer patients.
- Patients received second-line PTX + RAM followed by third-line nivolumab monotherapy.
- Comparison of nivolumab efficacy based on PFS <5 months versus PFS ≥5 months after PTX + RAM.
Main Results:
- The overall disease control rate was 62.1%, with a median PFS of 4.4 months and median overall survival (OS) of 11.9 months.
- Patients with PFS ≥5 months after PTX + RAM had significantly better PFS (5.3 vs. 2.8 months, P=0.039) and a trend towards better OS (15.2 vs. 6.9 months, P=0.066) with nivolumab.
- No significant association was found between first-line treatment outcomes and nivolumab response.
Conclusions:
- Prior paclitaxel and ramucirumab (PTX + RAM) treatment duration is associated with nivolumab's therapeutic effect in advanced gastric cancer.
- Patients achieving longer PFS after PTX + RAM may benefit more from subsequent nivolumab therapy.
- This suggests a predictive role for prior treatment response in guiding immunotherapy decisions for metastatic gastric cancer.
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