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In people whose lung cancer had already got past chemotherapy and immunotherapy, the Lung-MAP sub-study S1800A found that a blood-vessel blocker (ramucirumab) plus pembrolizumab helped them live longer than more chemotherapy did. A larger, simpler trial was launched to confirm it.
S1800A was the first Lung-MAP sub-study designed for patients whose non-small-cell lung cancer had progressed after immune checkpoint therapy, a group with no good standard. It randomised 166 patients to ramucirumab with pembrolizumab or to standard of care (docetaxel with or without ramucirumab, gemcitabine or pemetrexed), with overall survival as the primary endpoint of a phase 2 designed to detect a large signal.
Karen Reckamp and colleagues reported in the Journal of Clinical Oncology in 2022 that median overall survival was 14.5 months with the combination against 11.6 months with standard care, a hazard ratio of 0.69, with fewer severe side effects. Response rates were similar in both arms, so the benefit appeared to come from disease control rather than shrinkage, and progression-free survival was not significantly different.
Because a phase 2 survival signal in 166 patients is not proof, SWOG and the NCI opened Pragmatica-Lung (S2302), a deliberately simple phase 3 with minimal eligibility rules and data collection, to confirm the result in a population close to routine practice. S1800A also became the model for Lung-MAP's later immunotherapy-combination sub-studies in patients who have already had checkpoint blockade.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
Shares Ramucirumab, SWOG Cancer Research Network, Pemetrexed, Docetaxel.
Shares Lung-MAP (SWOG S1400 and S1900), Master protocol (platform, basket and umbrella trials), SWOG Cancer Research Network, Basket, umbrella, and platform trials.
Shares Ramucirumab, Docetaxel, Monoclonal antibodies, Immune checkpoint inhibitors.
Shares Master protocol (platform, basket and umbrella trials), SWOG Cancer Research Network, Basket, umbrella, and platform trials, National Cancer Institute (NIH).
Shares Master protocol (platform, basket and umbrella trials), SWOG Cancer Research Network, Basket, umbrella, and platform trials, National Cancer Institute (NIH).
Shares Pemetrexed, Gemcitabine, Pembrolizumab, Immune checkpoint inhibitors.
Shares PD-L1-high non-small-cell lung cancer without a driver mutation, Pembrolizumab, Immune checkpoint inhibitors, Non-small-cell lung cancer.
Shares Pemetrexed, Docetaxel, Gemcitabine, Monoclonal antibodies.