LBA38 - Interim safety and clinical activity in patients with advanced NSCLC from a multi-cohort phase 1 study of ramucirumab (R) plus pembrolizumab (P)

Date 10 October 2016
Event ESMO 2016 Congress
Session Immunotherapy of cancer
Topics Anticancer Agents
Non-Small Cell Lung Cancer
Biological Therapy
Presenter Roy Herbst
Citation Annals of Oncology (2016) 27 (6): 1-36. 10.1093/annonc/mdw435
Authors R.S. Herbst1, J. Martin-Liberal2, E. Calvo3, N. Isambert4, J.C. Bendell5, P. Cassier6, J.L. Perez-Gracia7, J. Yang8, J. Rege8, G. Mi9, D. Ferry8, L. Paz-Ares10
  • 1Thoracic Oncology Research Program, Yale University School of Medicine, 06520-8028 - New Haven/US
  • 2Early Drug Development Unit (uitm), Vall d'Hebron University Hospital, Barcelona/ES
  • 3Early Clinical Drug Development Program, START Madrid-HM CIOCC, Centro Integral Oncológico Clara Campal, Madrid/ES
  • 4Medicine, Centre Georges François Leclerc, Dijon/FR
  • 5Gi Oncology Research, Sarah Cannon Research Institute and Tennessee Oncology, 37203 - Nashville/US
  • 6Clinical Research, Centre Léon Bérard and Claude Bernard University, - - Lyon/FR
  • 7Medical Oncology, Universidad de Navarra, 31008 - Pamplona/ES
  • 8Oncology, Eli Lilly and Company, 08807 - Bridgewater/US
  • 9Oncology, Eli Lilly and Company, Indianapolis/US
  • 10Medical Oncology, Virgen del Rocio University Hospital, Seville/ES



Hallmarks of tumor growth include angiogenesis and immunosuppression. This is the first study to combine R (VEGFR2 antibody) with P (PD-1 antibody) to target both processes simultaneously. R and P have both shown clinical activity in multiple tumor types.


This ongoing phase 1a/b study (NCT02443324) enrolled pts with gastric or gastroesophageal junction (G/GEJ), NSCLC, urothelial carcinoma (UC), or biliary tract cancer (BTC) following progression on systemic therapy. The primary end point was to define safety and tolerability of adding R to P; preliminary efficacy will be examined. The DAKO PD-L1 22C3 IHC pharmDx assay was used to classify PD-L1 as strong pos (≥50%), weak pos (1-49%), or neg for NSCLC pts.


As of data cut-off on 23-June-2016, 91 pts have been enrolled with G/GEJ, UC or NSCLC and 66 (73%) experienced a treatment-related AE (TRAE). Fifteen (16%) pts experienced grade 3-4 TRAEs, most commonly colitis (4%) and hypertension (4%). One treatment related death occurred in the G/GEJ cohort (pneumocystis pneumonia and pulmonary sepsis). Pts with previously treated advanced NSCLC (n = 27) received R at 10 mg/kg on Day 1 with P 200 mg on Day 1 q3W. The median age was 65, 78% were male, 96% had a history of smoking, 78% had adenocarcinoma and 15% had squamous-cell carcinoma. Sixteen (59%) pts received ≥2 and 4 (15%) pts received ≥3 prior treatment regimens for their disease. Overall, 22 (81%) pts experienced a TRAE, most commonly asthenia (19%) and hypertension (19%). Two (7%) pts experienced grade 3-4 TRAEs (adrenal insufficiency, hyponatremia, delirium, and infusion related reaction). Eight (30%) pts had an objective response (1 unconfirmed). Responses occurred in both histological subtypes and all PD-L1 groups. The disease control rate was 85%. Median time to response was 1.45mo and median duration of response has not been reached. Median PFS has not been reached (95% CI, 3.98 to NR). Median duration of treatment is 6.8mo or longer. Objective responses were still ongoing in all responders.


R + P generated no new safety signals and demonstrated promising clinical activity in pts with previously treated advanced NSCLC, including PD-L1 neg pts.

Clinical trial identification


Legal entity responsible for the study

Eli Lilly and Company


Eli Lilly and Company


R.S. Herbst: funding from Merck and Lilly, and served as an advisory board member for AstraZeneca, Bristol-Myers Squibb, Genentech, Roche and Lilly. E. Calvo: Consulting-Novartis,GSK,Astellas,Roche,Lilly,Nanobiotech,Pfizer Speaker's Bureau -Novartis Research – Boehringer Ingelheim,Roche,BMS,Novartis,PsiOxus,Janssen,Eisai,Abbvie, OncoMed,Pharmamar,Puma Travel, Expenses – Lilly,PsiOxus,Novartis. P. Cassier: Grants/research - Roche/Genentech, Novartis, AstraZeneca, Celgene, Bayer, BluePrint, Amgen, Ignyta, Eli Lilly Co Honorarium - Roche, Novartis, Amgen. J.L. Perez-Gracia: Corporate Sponsored Research – Eli Lilly and Company. J. Yang, J. Rege, G. Mi, D. Ferry: Employment and stock ownership Eli Lilly and Company. L. Paz-Ares: Scientific advice - Roche, Lilly, Astra Zeneca, Merck Sharp, Boehringer Ing.,Bristol Meyers Squibb, Pfizer, Clovis Oncology, Novartis, Bayer, Amgen. All other authors have declared no conflicts of interest.