Ramucirumab plus pembrolizumab: can we make the maths work?
Mené sur 92 patients adultes ayant reçu 1 à 3 lignes de traitement pour un cancer gastrique ou un adénocarcinome de la jonction gastro-œsophagienne, un cancer du poumon non à petites cellules ou un carcinome urothélial (durée médiane de suivi : 32,8 mois), cet essai multicentrique de phase Ia/b évalue l’efficacité, du point de vue de la survie sans progression, et la toxicité du ramucirumab en combinaison avec le pembrolizumab
A 2015 analysis from The Cancer Genome Atlas identified gastroesophageal adenocarcinoma, non-small-cell lung cancer, and urothelial carcinomas as types of tumours with increased antigenic mutations, highlighting their predicted potential to respond to immunotherapy. Since 2015, the treatment of advanced gastroesophageal adenocarcinoma, non-small-cell lung cancer, and urothelial carcinoma has been fundamentally changed with the approval of immune checkpoint inhibitors such as PD-1 inhibitors. Anti-PD-1 and anti-PD-L1 antibodies have shown single-drug activity in these tumours in later-line settings, and antitumour activity when given as a combination therapy in all three cancer types in the JVDF trial presented by Roy Herbst and colleagues in The Lancet Oncology. Although patients with gastroesophageal adenocarcinoma, non-small-cell lung cancer, and urothelial carcinoma have varying responses and durations of responses to immune checkpoint inhibitors, objective responses according to Response Evaluation Criteria in Solid Tumors occur in few patients, albeit often characterised by durable and clinically relevant benefit. Several trials of combinatorial approaches seeking to expand the proportion of responders to immune checkpoint inhibitors are ongoing, and combinations of immune checkpoint inhibitors with anti-angiogenic therapies, including bevacizumab and the small molecule antiangiogenic multi-kinase inhibitor axitinib, have shown meaningful activity in larger trials.
The Lancet Oncology , commentaire, 2018