Cyramza Addition Does Not Improve Standard Treatment for Nonsquamous NSCLC

The gist: Cyramza, a drug recently approved for treating certain lung cancer patients, does not improve a standard treatment for stage IV non-small cell lung cancer (NSCLC). In a clinical trial, Cyramza was given to patients along with the drug pemetrexed (Alimta) and platinum chemotherapy. Some patients received only Alimta and platinum chemotherapy. None of the patients had yet been treated with chemotherapy. The researchers found that there was no significant difference between the two groups in terms of the amount of time that passed without their cancers worsening.

“In a study of patients with nonsquamous non–small cell lung cancer (NSCLC), the addition of ramucirumab (Cyramza) to pemetrexed (Alimta) and platinum chemotherapy did not significantly improve progression-free survival, according to a study by Doebele et al in Cancer. However, the investigators did suggest a possible clinical benefit of adding ramucirumab to established pemetrexed/platinum chemotherapy in patients with stage IV nonsquamous NSCLC not previously treated with chemotherapy.

“Studies have shown that patients with nonsquamous NSCLC who are treated with a combination of the platinum-containing agents pemetrexed and cisplatin have an overall survival of just 9 to 11 months. More recent studies in NSCLC have focused on the addition of targeted biologic agents, such as bevacizumab (Avastin), to platinum-containing chemotherapy to improve clinical outcomes. Bevacizumab, a humanized monoclonal antibody against the vascular endothelial growth factor ligand, is currently the only antiangiogenic agent approved for nonsquamous NSCLC. A correlation between VEGF receptor 2 (VEGFR2) expression and tumor microvessel density has been associated with a poor prognosis and lower relapse-free survival.

“With that in mind, Doebele and colleagues conducted a phase II study of the addition of ramucirumab to pemetrexed and platinum chemotherapy. Ramucirumab, a fully human immunoglobulin G1 monoclonal antibody, specifically binds to the extracellular domain of VEGFR2 with high affinity. The investigators wanted to determine whether the addition of ramucirumab to a standard first-line platinum-based combination chemotherapy regimen would result in prolonged progression-free survival….

“The results of this study indicate the addition of ramucirumab did not significantly prolong progression-free survival in patients with nonsquamous NSCLC. In addition, the overall response rate was not significantly improved for patients receiving ramucirumab vs those receiving only pemetrexed and platinum-based therapy. However, the investigators did suggest a possible clinical benefit of adding ramucirumab to established pemetrexed/platinum chemotherapy for the first-line treatment of nonsquamous NSCLC.”