Abstract 1037P
Background
Anti-angiogenesis plays a pivotal role in overcoming immunotherapy resistance. The combination of an anti-angiogenic agent and a checkpoint inhibitor offers a more robust treatment option in a wide variety of solid tumor types. Although taxane plus ramucirumab, an anti-angiogenesis agent, is widely used as the 2nd-line therapy in advanced metastatic non-small cell lung cancer (NSCLC), the combination of paclitaxel (Taxol) and ramucirumab with pembrolizumab (TRP) has not be investigated in immune-resistant/refractory NSCLC population.
Methods
A retrospective chart review was conducted in all patients with immune-resistant or refractory NSCLC treated with TRP between January 2019 and April 2022 at Banner MD Anderson Cancer Center.
Results
In total, 14 patients met the selection criteria, including five patients with immune-resistant disease (5/14, 36%) and nine patients with immune-refractory disease defined as progression within 3 months with monotherapy or 6 months with chemoimmunotherapy combination (9/14, 64%). All patients had previously received platinum and pembrolizumab. 11 patients benefited from the combination with clinical benefit rate (CBR, 11/14, 79%). Of 11 patients, 4 patients achieved PR (4/14, 29%) with duration of response (DoR) over 12.5 months with one patient is still responding; 7 patients had SD (7/14, 50%) with DoR of 12.3 months; 3 patients had PD (21%) by RECIST 1.1 criteria. Of interest, one patient with both STK 11 and KEAP 1 mutations achieved PR, two patients with STK 11 mutations had SD, and 2 other patients with either KEAP 1 or STK11/KEAP1 had PD. The combination was well tolerated, 1 patient developed G3 immune-mediated diarrhea, one patient developed pneumonitis, one patient developed left toe gangrene requiring amputation and 3 patients experienced Grade 3 fatigue.
Conclusions
Combination of TRP (Taxol, ramucirumab and Pembrolizumab) appears to be safe and very active against immune-resistant/refractory NSCLC and merits further investigation prospectively.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
J.J. Niu: Financial Interests, Personal, Advisory Board: Merck, AstraZeneca, Blueprint Medicines, Johnson & Johnson, BeiGene, Takeda, Mirati Therapeutics, Immvira, Bristol Myers Squibb, Exact Sciences; Financial Interests, Personal, Invited Speaker: Onclive, Naveris. All other authors have declared no conflicts of interest.