Atlas of Liquid Biopsy by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030698799
Publisher: Springer International Publishing

7.3.2 Second and Further Lines Treatment

Randomized trials have also established the role of chemotherapy after progression on first-line treatment. Irinotecan, Docetaxel, and Ramucirumab were shown to improve overall survival compared to best supportive care [35–37]. Additionally, Paclitaxel was shown to be at least as active as Irinotecan in two randomized trials [38, 39]. Recently, the addition of the anti-VEGFR2 monoclonal antibody Ramucirumab to Paclitaxel was associated with increased overall response rate, progression-free survival, and overall survival in the RAINBOW trial. According to the results of this study, Paclitaxel plus Ramucirumab is likely the most active second-line chemotherapy regimen currently available for patients with gastric cancer.

While the addition of Trastuzumab to the backbone of chemotherapy improved survival in the first-line setting, no other anti-HER2 treatment was associated with improved outcomes in the second-line setting, including Lapatinib, TDM-1, and maintenance Trastuzumab beyond progression [40–42]. Only recently, the antibody-drug conjugate (ADC) Trastuzumab deruxtecan was shown to be superior to single-agent chemotherapy in third- or further lines of treatment [43]. Regarding immunotherapy, while Pembrolizumab failed to demonstrate improved outcomes in the second-line setting in the KEYNOTE-061, data from the cohort 1 of the KEYNOTE 059 and from the ATTRACTION-2 trials support the use of Pembrolizumab and Nivolumab in the third-line setting, respectively [44, 45]. Importantly, Pembrolizumab is approved only for patients with tumor CPS (a marker of programmed cell death ligand 1 [PD-L1] expression) higher or equal to 1, while the evaluation of the expression of PD-L1 is not a prerequisite for the treatment with Nivolumab.

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