How will you decide who to offer ramucirumab + pembro after progression on chemoimmunotherapy?
In S1800A, overall survival benefit was relatively consistent across subgroups including TMB levels and PD-L1 strata. I would take into account the patient’s prior response to ICI (extent and duration) and the side effects from the ICI therapy. For instance, I would favor chemotherapy for those with...
As of today, I would offer ram/pembro to patients who were previously treated with IO, were not primary progressors, and who do not have imminent organ failure, pain, or other requirements for a rapid response. Notably, response rates to investigators-choice SOC (doce/ram, doce, gem, or pemetrexed) ...
A more pronounced benefit was seen with ramucirumab and pembrolizumab in patients with SCC or mixed histology NSCLC where options for therapy may be more limited. Overall, all subgroups did derive benefit.
Currently, ramucirumab + pembrolizumab is not an approved regimen by the FDA and is based on positive Phase II data from SWOG S1800A. Though the results were quite promising, it would be best to enroll patients in the confirmatory study SWOG S2302 (Pragmatica-Lung). In principle, at minimum, the par...
Assuming Pembrolizumab plus Ramucirumab is covered by insurance given it lacks FDA approval, I would consider using it when/if all the below criteria are met.
- No quick progression on prior PD1/PDL1 targeting therapy. S1800A required no progression within 12 weeks of prior therapy. This is intended t...