Currently Viewing:
Perspectives in the Management of Non-Small Cell Lung Cancer
Currently Reading
The REVEL Study in Lung Cancer
June 29, 2017
Rationale for Anti-Angiogenesis in Lung Cancer
June 22, 2017
Role of Immunotherapy in Lung Cancer
June 22, 2017
Deciding on Second-Line Lung Cancer Therapy
June 09, 2017

The REVEL Study in Lung Cancer

Roy S. Herbst, MD, PhD, reviews data from the REVEL clinical trial with ramucirumab plus docetaxel in squamous and nonsquamous non—small cell lung cancer.


Roy S. Herbst, MD, PhD: The REVEL trial compared docetaxel, a standard second-line lung cancer therapy, with docetaxel plus ramucirumab, the VEGFR2 antibody, and included both squamous and nonsquamous lung cancer. Actually, the toxicity results suggest that one could give the drug in both settings, and there was an improvement in survival across the board in both the squamous and nonsquamous settings. Off the top of my head, the hazard ratio was in the mid-0.8 range—not the highest ratio one has ever seen, but clinically and statistically significant.

There is some benefit. This drug was approved almost at the same time as nivolumab. Many people are, in the second-line setting, using nivolumab, which has relegated this regimen to the third-line setting, but I think that it is clearly better than docetaxel if one were going to use docetaxel, adding minimal additional side effects. I also believe that ramucirumab might have some role in immunotherapy in altering the microenvironment—in favor of the immune therapies working better.

Toxicities are managed in the usual ways. When you add ramucirumab to docetaxel, the main toxicity is still going to be neutropenia—probably only slightly exacerbated by the VEGF inhibitor—and certainly neuropathy. You would manage it with supportive care; treatment of febrile neutropenia, when that develops; and blood product repletion, if that’s needed. We’ve gotten pretty good at giving docetaxel. It’s a tough drug, but certainly very manageable.

In the second-line setting these days, most people would use immunotherapy unless they really have a reason not to. The reasons not to would be some sort of autoimmune disease, pneumonitis, psoriasis, something preexisting that would make you concerned about using an immune checkpoint inhibitor that would activate the immune system, or someone who is terribly symptomatic to the point where you are worried that the immunotherapy wouldn’t happen for more than 2 or 3 weeks before the patient needs something to be done for their symptoms. There, you would want the best
response you could get, and that would probably be with a docetaxel and ramucirumab combination.
 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!