Hossein Borghaei, DO, MS, Highlights Findings From the Phase 2 Lung-MAP trial Assessing Ramucirumab and Pembrolizumab in Advanced NSCLC

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.

Transcript:

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.

Reference

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