Effect of Ramucirumab Plus Paclitaxel in Advanced Gastric Cancer According to the Status of Programmed Cell Death-ligand 1 (PD-L1) Expression

Overview

Journal J Gastrointest Oncol

Date 2024 Jan 10

PMID 38196548

Authors

Dae-Ho Choi

Jeeyun Lee

Ho Yeong Lim

Won Ki Kang

Jae Yeon Jang

Youngkyung Jeon

Sun Young Jeong

Ye Ji Jung

Seung Tae Kim

Affiliations

Soon will be listed here.

Abstract

Background: Ramucirumab, an anti-vascular endothelial growth factor receptor (VEGFR) monoclonal antibody (mAb), inhibits angiogenesis and reduces tumor activity. Programmed cell death-ligand 1 (PD-L1) might act upon VEGFR2 to induce cancer cell angiogenesis and metastasis. Herein, we investigated the efficacy of combining ramucirumab and paclitaxel according to the status of PD-L1 expression in patients with advanced gastric cancer (AGC).

Methods: This analysis included AGC patients who received ramucirumab plus paclitaxel as 2 line therapy between December 1, 2018, and February 28, 2022, at Samsung Medical Center. All patient data analyses included an evaluation of PD-L1 expression using the combined positive score (CPS). We analyzed the efficacy and the survival of patients according to their PD-L1 expression.

Results: We included 117 patients in this analysis, and 80 patients (68.4%) had a PD-L1 CPS of one or more, 37 (31.6%) had five or more, and 19 (16.2%) had ten or more scores. Progression-free survival (PFS) and overall survival (OS) did not differ significantly between patients with a PD-L1 CPS of less than one and one or more {PD-L1 <1% PD-L1 ≥1%; PFS: median 3.6 months [95% confidence interval (CI): 2.4-4.8 months] median 4.1 months (95% CI: 3.5-4.7 months), P=0.93; PD-L1 <1% PD-L1 ≥1%; OS: median 7.0 months (95% CI: 5.4-8.6 months) median 8.1 months (95% CI: 6.4-9.8 months), P=0.32}. PFS and OS did not differ significantly between patients with a PD-L1 CPS of less than 5 and 5 or more [PD-L1 <5% PD-L1 ≥5%; PFS: 3.9 months (95% CI: 3.3-4.5 months) 4.4 months (95% CI: 3.0-5.8 months), P=0.57; OS: 7.4 months (95% CI: 6.5-8.3 months) 10.0 months (95% CI: 1.1-18.9 months), P=0.07]. Interestingly, with a PD-L1 CPS cutoff of 10, PFS and OS did differ significantly [PD-L1 <10% PD-L1 ≥10%; PFS: 3.8 months (95% CI: 3.3-4.3 months) 5.7 months (95% CI: 4.1-7.3 months), P=0.05; OS: 7.2 months (95% CI: 6.5-7.9 months) 18.9 months (95% CI: 6.5-31.3 months), P=0.04].

Conclusions: No biomarkers have been established to predict survival times after ramucirumab plus paclitaxel treatment. This analysis suggests that a PD-L1 CPS cutoff of 10 might be novel a biomarker to predict the survival of AGC patients treated with ramucirumab and paclitaxel.

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