Docetaxel plus ramucirumab immediately after immunotherapy in advanced NSCLC: A phase II study (DRUN)

Docetaxel plus ramucirumab is a standard second-line treatment for advanced non-small cell lung cancer (NSCLC). Prior immunotherapy has been suggested to potentially affect the efficacy of subsequent docetaxel plus ramucirumab, but prospective evidence is limited.

This multicenter, single-arm, phase II study enrolled patients with advanced NSCLC. Eligible patients had experienced disease progression following a prior immune checkpoint inhibitor (ICI)-containing regimen. Patients received docetaxel 60 mg/m² and ramucirumab 10 mg/kg every 3 weeks. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and safety. This study was registered in the Japan Registry of Clinical Trials (jRCT1051190091).

Between January 8, 2020, and January 7, 2024,We evaluated 33 patients for efficacy and safety. The median age was 69 years, and 26 patients (79%) had an Eastern Cooperative Oncology Group performance status of 1. The ORR was 33.3% (90% confidence interval [CI], 19.9-49.1), and the DCR was 90.9% (90% CI, 78.1-97.5). The median PFS and OS were 4.9 months (95% CI, 4.4-6.2) and 11.8 months (95% CI, 9.8-18.8), respectively. No new safety signals were observed. Patients who had responded to prior ICI-containing therapy had longer PFS than those who had not responded (hazard ratio, 0.34; 95% CI, 0.14-0.76).

Although the primary endpoint was not met, docetaxel plus ramucirumab demonstrated antitumor activity consistent with previous reports and manageable safety in the post-ICI setting. Efficacy appeared more pronounced in patients with prior response to ICI-containing therapy.