Efficacy and Safety of Ramucirumab With Docetaxel Versus Placebo With Docetaxel as Second-Line Treatment of Advanced Non–Small-Cell Lung Cancer: A Subgroup Analysis According to Patient Age in the REVEL Trial

• Published in: Clinical lung cancer 2018-05, Vol.19 (3), p.270-279.e3
• Main Authors: Ramalingam, Suresh S., Pérol, Maurice, Reck, Martin, Kowalyszyn, Ruben Dario, Gautschi, Oliver, Kimmich, Martin, Cho, Eun Kyung, Czyzewicz, Grzegorz, Grigorescu, Alexandru, Karaseva, Nina, Dakhil, Shaker, Lee, Pablo, Zimmerman, Annamaria, Sashegyi, Andreas, Alexandris, Ekaterine, Carter, Gebra Cuyun, Winfree, Katherine B., Garon, Edward B.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Angiogenesis; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Docetaxel - administration & dosage; Docetaxel - adverse effects; Double-Blind Method; Elderly; Female; Humans; Kaplan-Meier Estimate; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Male; Middle Aged; NSCLC; Phase 3; Ramucirumab; Salvage Therapy - methods; Vascular Endothelial Growth Factor Receptor-2 - antagonists & inhibitors; VEGF; Young Adult
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2017.12.011

An age subgroup analysis was conducted on patients with non–small-cell lung cancer from the REVEL trial (younger than 65 years: n = 798; 65 years or older: n = 455). Ramucirumab in combination with docetaxel showed no significant additional risks to older patients. This second-line study suggests ramucirumab treatment was more pronounced in patients younger than 65 years. Ramucirumab, a recombinant human immunoglobulin G1 monoclonal antibody receptor antagonist designed to block the ligand-binding site of vascular endothelial growth factor receptor-2 (VEGFR-2), was evaluated as second-line treatment in combination with docetaxel in patients with non–small-cell lung cancer in the REVEL trial (NCT01168973). Ramucirumab significantly improved overall survival (OS) and progression-free survival (PFS). We report age subgroup analysis results primarily on the basis of a 65-year cutoff. Patients were randomized 1:1 to ramucirumab with docetaxel or placebo with docetaxel (n = 1253). Of these, 798 were younger than 65 years (ramucirumab, n = 391; control, n = 407) and 455 were 65 years or older (ramucirumab, n = 237; control, n = 218). Treatment comprised 21-day cycles of 75 mg/m2 docetaxel with 10 mg/kg ramucirumab or placebo. Prespecified age subgroup analyses were performed, including OS, PFS, and objective response rate. Quintiles age analysis was conducted to establish a relationship between efficacy and age. The Lung Cancer Symptom Scale (LCSS) measured quality of life outcomes. Safety was assessed according to adverse events (AEs). Patients younger than 65 years showed favorable OS outcomes with ramucirumab treatment (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.62-0.87; P < .001) and PFS (HR, 0.68; 95% CI, 0.59-0.79; P < .001). In patients 65 years or older, benefits of ramucirumab were not as evident; after model adjustment for prognostic factors, OS and PFS HRs were 0.96 (95% CI, 0.77-1.21; P = .04) and 0.87 (95% CI, 0.71-1.05; P = .03), respectively. Age analysis according to quintiles showed HRs favoring ramucirumab for all age groupings. LCSS scores and AEs did not considerably differ between age groups. In this subgroup analysis, true treatment effect differences on the basis of age have not been established, and treatment should not be deterred solely because of age.