Outcomes of Ramucirumab Monotherapy for Advanced Gastric Cancer in a Multi-institutional Cohort Study in Japan

The REGARD trial resulted in insurance approval for ramucirumab monotherapy; however, it did not include Japanese patients. Subsequent phase II trials and retrospective studies have examined Japanese cohorts, but reports identifying prognostic factors remain limited.

A total of 27 patients across six institutions received ramucirumab monotherapy as a second-line treatment for gastric cancer between September 2017 and December 2019.

The median age of 27 patients was 74 years (range: 36-90). Eighteen patients were male, and ten had intestinal-type gastric cancer. Metastases were observed in 6 patients in the liver, 3 in the lung, 18 in lymph nodes, and 14 in the peritoneum. Third-line chemotherapy was administered to 6 patients. The response rate was 3.7%, and the disease control rate was 18.5%. The median progression-free survival was 2.1 months, and the median overall survival was 3.0 months. Of the 27 patients, 6 received third-line treatment and 4 received nivolumab alone. Overall survival did not differ significantly between patients who received third-line treatment and those who did not. The median progression-free survival showed no significant differences based on tumor markers (carcinoembryonic antigen and CA19-9), age, histology, or metastases in the lung, lymph nodes, or peritoneum. In contrast, liver metastases were associated with poorer progression-free survival (HR:4.735 (95% CI: 1.508-14.86) and overall survival HR:2.906 (95% CI: 1.031-8.189).

Ramucirumab monotherapy is selected for patients with poor general condition, but it is suggested to have a poor prognosis, particularly in cases with liver metastases.