Ramucirumab plus triplet chemotherapy as an alternative salvage treatment for patients with metastatic colorectal cancer

• Published in: Journal of the Formosan Medical Association Vol. 121; no. 10; pp. 2057 - 2064
• Main Authors: Liang, Yi-Hsin, Liang, Jin-Tung, Lin, Ben-Ren, Huang, John, Hung, Ji-Shiang, Lai, Shuo-Lun, Chen, Tzu-Chun, Tsai, Jia-Huei, Cheng, Yung-Ming, Tsao, Ting-Han, Hsu, Wen-Ling, Chen, Kuo-Hsing, Yeh, Kun-Huei
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.10.2022; Elsevier
• Subjects: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Colorectal Neoplasms - etiology; Fluorouracil; FOLFOXIRI; Humans; Metastatic colorectal cancer; Ramucirumab; Rectal Neoplasms; Retrospective Studies; Salvage Therapy; Triplet chemotherapy; Ramucirumab; Triplet chemotherapy; FOLFOXIRI; Metastatic colorectal cancer
• ISSN: 0929-6646; 1876-0821
• DOI: 10.1016/j.jfma.2022.02.019

Ramucirumab is indicated for salvage treatment after failure of first-line treatment for metastatic colorectal cancer (mCRC). However, the application of ramucirumab at later-line treatment in real-world practice has not received much discussion. In this retrospective study, we enrolled 70 patients with mCRC who received ramucirumab plus chemotherapy at National Taiwan University Hospital between 2018 and 2019. Compared with those who received third- or later-line ramucirumab treatment, patients who received second-line ramucirumab treatment had significantly longer median time to treatment discontinuation (mTTD; 6.7 vs 3.6 months, P = .004) and median overall survival (mOS; not reached vs 7.6 months, P = .009). Multivariate analyses revealed that second-line ramucirumab and triplet chemotherapy backbone were the only independent predictive factors for long mTTD and mOS. Patients who received ramucirumab with triplet chemotherapy had a significantly longer mOS than did patients who received ramucirumab with doublet chemotherapy (not reached vs 5.6 months, P = .002). Among those receiving second-line ramucirumab treatment, combination with triplet chemotherapy led to a longer mTTD than did combination with doublet chemotherapy, but the difference was non-significant (not reached vs 4.4 months, P = .108). By contrast, in patients receiving fourth- or later-line ramucirumab, combination with triplet chemotherapy led to significantly longer mTTD than did combination with doublet chemotherapy (8.0 vs 2.9 months, P = .032). Ramucirumab plus triplet chemotherapy may be an alternative regimen in patients with mCRC, particularly as a later-line treatment modality.