At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Hossein Borghaei, DO, MS, chief of the Division of Thoracic Medical Oncology, professor of the Department of Hematology/Oncology, co-director of the Immune Monitoring Facility, and the Gloria and Edmund M. Dunn Chair in Thoracic Oncology at the Fox Chase Cancer Center in Philadelphia, spoke with CancerNetwork® about the importance of the phase 2 Lung-MAP trial (NCT03851445), specifically the S1800 A substudy (NCT03971474) assessing ramucirumab (Cyramza) and pembrolizumab (Keytruda) in a population of patients with advanced non–small cell lung cancer previously treated with immunotherapy.
In a population of 136 patients, the doublet regimen resulted in a statistically significant improvement in overall survival (OS) over standard of care (HR, 0.69; 95% CI, 0.51-0.92; P = .05). The median OS was 14.5 months (95% CI, 13.9-16.1) in the experimental arm vs 11.6 months (95% CI, 9.9-13.0) in the control arm.
In the world of lung cancer, probably one of the more important presentations was the Lung-MAP study. In full disclosure, I'm heavily involved with Lung-MAP at a couple of different levels. The study of ramucirumab plus pembrolizumab in patients with evidence of disease progression after frontline treatment was an interesting study. It’s a randomized phase 2 study. It’s a real-world study where in the control arm a majority of patients were treated with a combination of docetaxel and ramucirumab and there were other single agent drugs [used]. The data clearly show that there’s an [OS] advantage for the combination of ramucirumab plus pembrolizumab in this patient population we have defined as having acquired resistance to immunotherapy or PD-1/PD-L1 agents that we use in the clinic right now.
The study to me points to a future phase 3 trial to try to establish this [regimen] as a potential standard of care. [We may be able to] prove in a phase 3 setting that compared with the standard of care this combination is more effective in terms of improving OS. I’m sure there’s going to be an additional biomarker and/or correlative studies that are going to be conducted as a result of this. From a clinical point of view, [this] was an interesting presentation. There were other interesting talks and discussions but from a point of view of whether there was something immediately practice changing in the world of lung cancer, I would just say perhaps Lung-MAP, but [there was] not anything that I would say changes how we care for our patients in a clinical setting [at this moment].
The poster sessions were good because we were introduced to a series of potential biomarkers to define patients who would truly benefit from immunotherapy. Some of those promises are already appearing as publications and manuscripts. That’s a good thing. There was [also] an intense amount of interest in liquid biopsy platforms and how to incorporate that better into the clinical practice. [There were] a lot of practice-refining ideas that came out of out of the ASCO meeting. Overall, I took a lot back from it and we’ll see where the future studies go.
Reckamp KL, Redman MW, Dragnev KH, et al. Overall survival from a phase II randomized study of ramucirumab plus pembrolizumab versus standard of care for advanced non–small cell lung cancer previously treated with immunotherapy: Lung-MAP nonmatched substudy S1800A. J Clin Oncol. 2022;40(suppl 16):9004. doi:10.1200/JCO.2022.40.16_suppl.9004