Docetaxel and Ramucirumab as Subsequent Treatment After First-Line Immunotherapy-Based Treatment for Metastatic...

Background: A combination of docetaxel and ramucirumab represents a standard of care in second-line treatment for patients with advanced NSCLC. Evidence of the regimen's efficacy is based on the results of the REVEL trial conducted in the pre-immunotherapy (immune checkpoint inhibitors-ICIs) era. Given the lack of randomized trials after the use of ICIs in front-line therapy, a question remains regarding the impact of the combination when disease progresses after ICI-based therapy. Methods: From 1 January 2018 to 31 December 2024, 55 patients from three oncology centers who had documented progression on ICI-based therapy subsequently received docetaxel/ramucirumab, and we reviewed their outcomes. Results: The studied group's median progression-free survival (PFS) was 5.8 months, while the median overall survival (OS) was 11.1 months. The objective response rate (ORR) and disease control rate (DCR) were 42% and 76%, respectively. Patients who had received ICI-based therapy for ≥6 months had a numerically better median PFS and statistically significant OS compared to those who had experienced progression on ICI-based therapy in <6 months. Regarding adverse events (AEs), 92.7% of patients experienced Grade 1-2 AEs, whereas 54.5% experienced Grade ≥ 3 AEs. One death due to GI bleeding was also recorded. Conclusion: Docetaxel/ramucirumab is an acceptable regimen for patients progressing on first-line ICI-based therapies. Our results are in concordance with the REVEL study and other retrospective studies of this combination after ICIs.