Uprety Dipesh
Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Biologics. 2019 Jul 22;13:133-137. doi: 10.2147/BTT.S175034. eCollection 2019.
Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small-cell lung cancer (NSCLC) accounts for about 85% of all lung cancer cases and approximately 70% of patients with NSCLC have locally advanced or metastatic disease at presentation. In NSCLC patients with advanced or metastatic disease, second line treatment with chemotherapy is associated with a poor response rate. In this article, we have reviewed the role of ramucirumab in patients with NSCLC. Ramucirumab is not current standard of care in the first line setting in the treatment of advanced or metastatic NSCLC, based on phase II data which did not show any progression-free survival (PFS) and overall survival (OS) benefit when ramucirumab was compared with non-ramucirumab arm. The REVEL study was a phase III, placebo-controlled trial which included patients with stage IV NSCLC who had progressed during or after platinum-based chemotherapy, with or without bevacizumab. Median OS was 9.1 months vs 10.5 months (HR 0.86, 95% CI 0.75-0.98) in the placebo and ramucirumab group respectively. Seventy-nine percent of patients in ramucirumab arm and 71% of patients in non-ramucirumab arm had grade ≥3 treatment-related adverse events. The addition of ramucirumab to docetaxel can be considered in younger patients with good performance status as a second line treatment option. Additionally, combined blockage of the VEGFR and EGFR pathway has been utilized to overcome resistance to EGFR therapy. The RELAY trial was a phase III, placebo-controlled trial which included patients with sensitizing EGFR mutation positive stage IV NSCLC. Patients were randomized to either ramucirumab plus erlotinib or erlotinib. The trial showed that the combination therapy showed superior PFS benefit.
肺癌是全球癌症相关死亡的主要原因。非小细胞肺癌（NSCLC）约占所有肺癌病例的85%，约70%的NSCLC患者在确诊时已处于局部晚期或转移性疾病阶段。在患有晚期或转移性疾病的NSCLC患者中，二线化疗的缓解率较低。在本文中，我们回顾了雷莫西尤单抗在NSCLC患者中的作用。基于II期数据，雷莫西尤单抗在晚期或转移性NSCLC一线治疗中并非当前的标准治疗方案，该数据显示，与非雷莫西尤单抗组相比，雷莫西尤单抗并未显示出任何无进展生存期（PFS）和总生存期（OS）获益。REVEL研究是一项III期、安慰剂对照试验，纳入了在铂类化疗期间或之后病情进展且接受或未接受贝伐单抗治疗的IV期NSCLC患者。安慰剂组和雷莫西尤单抗组的中位OS分别为9.1个月和10.5个月（HR 0.86，95%CI 0.75 - 0.98）。雷莫西尤单抗组79%的患者和非雷莫西尤单抗组71%的患者发生了≥3级治疗相关不良事件。对于身体状况良好的年轻患者，可考虑将雷莫西尤单抗添加到多西他赛中作为二线治疗选择。此外，联合阻断VEGFR和EGFR通路已被用于克服对EGFR治疗的耐药性。RELAY试验是一项III期、安慰剂对照试验，纳入了具有敏感EGFR突变阳性的IV期NSCLC患者。患者被随机分为雷莫西尤单抗联合厄洛替尼组或厄洛替尼组。该试验表明，联合治疗显示出更好的PFS获益。
