PP225 Real-world data of ramucirumab plus docetaxel compared with docetaxel after immune-checkpoint inhibitors in stage IV non-small cell lung cancer patients

Non-small cell lung cancer (NSCLC) is a leading cause of cancer death worldwide. Ramucirumab plus docetaxel became one of the available options for subsequent treatment in NSCLC after REVEL study. In addition, immune-checkpoint inhibitors (ICIs) became standard of treatment for NSCLC. Combining ICIs with anti-vascular endothelial growth factor blockade is one of many tries to overcome the resistance. We present our real-world data of ramucirumab plus docetaxel compared with docetaxel after ICIs in stage IV NSCLC patients. We retrospectively collected clinicopathologic data of NSCLC patients who were treated with ramucirumab plus docetaxel or docetaxel for second to fourth line of treatment after ICIs from 1st January 2019 to 31th October 2021 in Samsung Medical Center. After patients with EGFR, ALK or ROS1 mutations were excluded, 38 patients in ramucirumab/docetaxel group and 183 patients in docetaxel group were included in the analysis. Primary endpoint was progression-free survival (PFS), and secondary endpoints were overall survival (OS) and overall response rate (ORR). Variables of age, treatment line were significantly different between two groups. Ramucirumab/docetaxel showed significantly better PFS than docetaxel alone after ICIs (p = 0.012) in this analysis. Hazard ratio was 0.59 (95% confidence interval 0.37 – 0.96). Median PFS was 6 months in ramucirumab/ docetaxel group, and 2 months in docetaxel group. In multivariable analysis for PFS with cox proportional hazard regression, only treatment group and histology showed significant differences. Ramucirumab/ docetaxel group had a significantly better response than docetaxel group (p = 0.019). 14 (36.8%) and 47 (25.7%) in ramucirumab/docetaxel group and docetaxel group each achieved partial response. Only one patient who were treated with docetaxel showed complete response among all patients. 18 (47.4%) patients in ramucirumab/docetaxel group and 68 (37.2%) patients in docetaxel group showed stable disease as a best response. However, there was no significant benefit regarding OS in this analysis (p = 0.45) and even docetaxel tends to prolong OS than ramucirumab/docetaxel. Ramucirumab plus docetaxel showed significantly higher PFS compared with docetaxel alone after ICIs in stage IV NSCLC in this analysis of real-world data. ORR was also significantly higher in ramucirumab/docetaxel group than docetaxel alone group. However, OS was not significantly different between two groups in this study.