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Docetaxel with or without Ramucirumab after Platinum-Based Chemotherapy and Checkpoint Inhibitors in Advanced Urothelial Carcinoma: A Pre-Specified Subgroup Analysis from the Phase 3 RANGE Trial
- Source :
- Bladder Cancer, 6(1), 43-52. IOS Press
- Publication Year :
- 2020
-
Abstract
- BACKGROUND: The phase 3 RANGE trial found ramucirumab/docetaxel improved progression-free survival (PFS) versus placebo/docetaxel (median 4.1 vs 2.8 months; hazard ratio [HR] = 0.757, p = 0.0118) for treatment of platinum-refractory metastatic urothelial carcinoma (UC). Some patients received an immune checkpoint inhibitor (ICI) prior to RANGE. In other studies, unselected patients with platinum-refractory UC exhibited an overall response rate (ORR) of 15–31% to ICIs. OBJECTIVE: Efficacy and safety data from the subgroup of patients treated with prior ICI were examined using prespecified analyses to compare outcomes between RANGE treatment arms. METHODS: Randomized, double-blind RANGE study (n = 530) took place July 2015-April 2017 in 23 countries. Forty-five patients (8.5%) received prior ICI. PFS was evaluated using the Kaplan-Meier method and unstratified Cox proportional hazards model. RESULTS: 17 ramucirumab/docetaxel arm, 28 placebo/docetaxel arm patients were treated with an ICI. The prior-ICI ramucirumab subgroup had worse Bellmunt scores at baseline versus placebo (score of 2-3 : 70.6% vs 25%, respectively). Most patients (84.4%) received the ICI immediately following platinum and immediately prior to RANGE. ORR to prior ICI was 6.7% Responses were achieved by 5/17 (29.4%) on ramucirumab/docetaxel, compared to 2/28 (7.1%) on placebo/docetaxel. Median PFS was 3.15 months on ramucirumab/docetaxel versus 2.73 months on placebo/docetaxel (HR = 0.786, 95% CI = 0.404–1.528, p = 0.4877). The frequency of grade≥3 adverse events was similar between arms. Limitations include sample size and treatment setting of the analyzed population. CONCLUSIONS: Ramucirumab/docetaxel may provide a clinical benefit with acceptable safety in the third-line setting for metastatic UC patients whose disease has progressed on both prior platinum chemotherapy and ICI therapy.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_specialty
ramucirumab
Urology
medicine.medical_treatment
Population
Subgroup analysis
Immune checkpoint inhibitor
Placebo
Ramucirumab
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
education
urothelial carcinoma
education.field_of_study
Chemotherapy
VEGFR inhibitor
Proportional hazards model
business.industry
Hazard ratio
platinum-refractory
030104 developmental biology
Docetaxel
030220 oncology & carcinogenesis
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 23523727
- Volume :
- 6
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Bladder Cancer
- Accession number :
- edsair.doi.dedup.....9131c145fbae3b8eeeb9001f6d11400d