Ramucirumab offers survival benefits in gastric cancer
Patients with advanced gastric cancer survive for significantly longer when treated with ramucirumab compared with placebo, according to the results of a phase III clinical trial published online last week (Lancet, 3 October 2013).
The international trial, known as REGARD, investigated whether the overall survival rate in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma was improved when patients were given ramucirumab compared with placebo. Patients were aged between 24 and 87 years and had experienced disease progression after first-line platinum-containing or fluoropyrimidine-containing chemotherapy.
Patients were randomly assigned to a study group and received best supportive care and either ramucirumab (8mg/kg, n=238) or placebo (n=117) intravenously every two weeks.
Median overall survival was 5.2 months in patients receiving ramucirumab, compared with 3.8 months for patients receiving placebo (hazard ratio 0.776, 95 per cent confidence interval 0.603-0.998: P=0.047). The rate of disease control was also significantly higher in patients given ramucirumab than in those given placebo.
Hypertension was more common in patients receiving ramucirumab, with 8 per cent experiencing grade 3 hypertension compared with 3 per cent of the placebo group, but rates of other adverse events were similar for both groups.
An accompanying editorial (ibid), titled “Angiogenesis in gastric cancer: hitting the target?”, states: “Ramucirumab will probably emerge as an alternative to chemotherapy in patients with gastric cancer and disease progression after first-line chemotherapy.”
However, Steve Williamson, consultant cancer pharmacist at Northumbria and North Cumbria NHS Trusts, said that the survival benefit was very modest and there was only limited evidence of improvement in quality of life. He added: “This . . . means ramucirumab is unlikely to score highly on the scoring tool used to assess applications to the national cancer drug fund. There is also a question around its comparison to using second-line chemotherapy which has similar clinical benefit but is potentially cheaper.”
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11128649