Efficacy of Docetaxel Plus Ramucirumab for Malignant Pleural Effusion and Cerebral Edema in Patients With Advanced Non‐Small Cell Lung Cancer: A Single‐Institution Retrospective Study

BACKGROUND: Malignant pleural effusion (MPE) is associated with a poor prognosis and quality of life in patients with non-small cell lung cancer (NSCLC). Additionally, cerebral edema can lead to neurological symptoms that adversely affect activities of daily living. While bevacizumab has demonstrated efficacy in treating both MPE and cerebral edema, there is limited research on ramucirumab, an angiogenesis inhibitor. Therefore, this study aimed to evaluate the efficacy of docetaxel combined with ramucirumab for the management of MPE and cerebral edema. METHODS: We retrospectively analyzed medical records of patients with advanced NSCLC who received docetaxel in conjunction with ramucirumab at Shizuoka Cancer Center between August 2016 and March 2023. The primary endpoints were pleural effusion progression-free survival (PE-PFS) and the cerebral edema control rate. Secondary endpoints included response rate, progression-free survival (PFS), overall survival (OS), and the incidence of toxicities. RESULTS: A total of 163 patients were included. The median PE-PFS was 8.1 months (95% CI: 4.8-12.0 months). The pleural effusion control rate was 87%, whereas the cerebral edema control rate was 26%. The response rate was 26%, with a median PFS of 4.4 months (95% confidence interval [CI]: 3.7-5.1 months) and a median OS of 11.1 months (95% CI: 9.2-16.0 months). Adverse events leading to discontinuation of treatment occurred in 30% of patients for docetaxel and 33% for ramucirumab, with fatigue being the most common reason for discontinuation. CONCLUSION: Docetaxel plus ramucirumab was effective in controlling pleural effusion but showed limited effects on cerebral edema.