Retrospective observational study of salvage line ramucirumab monotherapy for patients with advanced gastric cancer

• Main Authors: Sadayuki Kawai, Naoki Fukuda, Shun Yamamoto, Seiichiro Mitani, Katsuhiro Omae, Takeru Wakatsuki, Ken Kato, Shigenori Kadowaki, Daisuke Takahari, Narikazu Boku, Kei Muro, Nozomu Machida
• Format: Article
• Language: English
• Published: BMC 2020-04-01
• Series: BMC Cancer
• Subjects: Stomach neoplasms; Drug therapy; Salvage therapy; Ramucirumab
• Online Access: http://link.springer.com/article/10.1186/s12885-020-06865-7

Abstract Background Ramucirumab monotherapy as a second-line treatment for advanced gastric cancer (AGC) prolongs survival compared to the best supportive care. However, in clinical practice, ramucirumab monotherapy is sometimes used as third- or later-line treatment for AGC refractory to fluoropyrimidine and taxanes. This study evaluated the efficacy and safety of salvage-line ramucirumab monotherapy for treating AGC. Methods The subjects of this retrospective study were advanced gastric or gastro-esophageal junction adenocarcinoma patients who received ramucirumab monotherapy after failure of 2 or more prior regimens containing fluoropyrimidine and taxanes but not ramucirumab. Results From June 2015 to April 2017, 51 patients were enrolled. The median progression-free survival (PFS) and overall survival (OS) were 1.8 (95% confidence interval [CI] = 1.6–2.2) and 5.1 (95% CI = 4.0–6.8) months, respectively. The objective response and disease control rates were 2 and 17%, respectively. Grade 3 adverse events (AEs; e.g., anemia, fatigue, hypertension, proteinuria, intestinal bleeding) occurred in seven (13%) patients, but no grade 4 AEs and treatment-related deaths were observed. A neutrophil–lymphocyte ratio (NLR) of < 2.5 and previous gastrectomy were associated with better PFS. Conclusions Salvage-line ramucirumab monotherapy has acceptable toxicity and comparable efficacy to second-line treatment; therefore, we consider physicians might choose this therapy as a salvage-line treatment option for AGC refractory to the standard therapies.