摘要
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FOLFOX plus nivolumab represents a standard of care for first-line therapy of advanced gastroesophageal cancer (aGEC) with positive PD-L1 expression. The efficacy of second-line VEGFR-2 inhibition with ramucirumab (RAM) plus chemo...
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FOLFOX plus nivolumab represents a standard of care for first-line therapy of advanced gastroesophageal cancer (aGEC) with positive PD-L1 expression. The efficacy of second-line VEGFR-2 inhibition with ramucirumab (RAM) plus chemotherapy after progression to immunochemotherapy remains unclear. Medical records of patients with aGEC enrolled in the randomized phase II AIO-STO-0417 trial after treatment failure to first-line FOLFOX plus nivolumab and ipilimumab were retrospectively analyzed. Patients were divided into two groups based on second-line therapy: RAM plus chemotherapy (RAM group) or treatment without RAM (control group). Eighty three patients were included. In the overall population, progression-free survival (PFS) in the RAM group was superior to the control (4.5 vs 2.9 months). Responders (CR/PR) to first-line immunochemotherapy receiving RAM containing second-line therapy had prolonged OS from start of first-line therapy (28.9 vs 16.5 months), as well as second-line OS (9.6 vs 7.5 months), PFS (5.6 vs 2.9 months) and DCR (53% vs 29%) compared to the control. PD-L1 CPS >= 1 was 42% and 44% for the RAM and the control, respectively. Patients with CPS >= 1 in the RAM group showed better tumor control (ORR 25% vs 10%) and improved survival (total OS 11.5 vs 8.0 months; second-line OS 6.5 vs 3.9 months; PFS 4.5 vs 1.6 months) compared to the control. Prior exposure to first-line FOLFOX plus dual checkpoint inhibition followed by RAM plus chemotherapy shows favorable response and survival rates especially in patients with initial response and positive PD-L1 expression and has the potential to advance the treatment paradigm in aGEC.Evidence suggests that immunochemotherapy followed by second-line treatment with ramucirumab, a vascular endothelial growth factor receptor (VEGF) inhibitor, potentially boosts treatment response in patients with advanced gastroesophageal cancer (aGEC). Here, to more thoroughly explore this possibility, the authors analyzed data from a phase II trial involving aGEC patients treated with ramucirumab after failing first-line immunochemotherapy. Improved tumor control and lengthened survival were observed in patients following second-line ramucirumab-containing therapy. The benefit was greatest among patients who initially responded to first-line therapy and whose tumors expressed programmed-death ligand-1. The findings indicate that integration of VEGF-targeted agents into immunochemotherapy-based regimens improves aGEC survival. image
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