Ramucirumab with paclitaxel or FOLFIRI as second-line treatment in docetaxel-pre-treated patients with metastatic gastric cancer in real-world setting

Abstract

Introduction. Ramucirumab (R) with paclitaxel (PTX) is a global standard for second-line (2L) therapy in advanced gastroesophageal adenocarcinoma (GEA). More and more patients (pts) get treated with taxanes in the perioperative or 1st line metastatic setting. For those pts the benefit of a combination of R+P is unclear, and many physicians would choose an irinotecan based regimen as 2L. We present data of retrospective analysis from pts with GEA with docetaxel-containing 1st line treated with ramucirumab and paclitaxel (R+PTX) or FOLFIRI (R+FOLFIRI) as 2L in a «real-life» setting.Materials and methods. We identified 46 docetaxel pre-treated pts from RAMSELGA data-base who received R+PTX (n = 19) or R+FOLFIRI (n = 27) as 2L.Results and discussion. The median progression-free survival (MPFS) and median overall survival (MOS) for pts treated with R+PTX were 7.9 (95% ДИ: 6.2–9.7) and 18.1 (15.1–21.2) months, and those for pts treated with R+FOLFIRI – 7.1 (95% ДИ: 4.3–9.9) and 15,8 (12.1–19.5) months, respectively. There are no significant differences. Main adverse events of special interest were hypertension grade (gr) 1-2, epistaxis gr 1-2: 78.9% и 21.1% in R+PTX group and 29.6% и 22.2% in R+FOLFIRI group, there were serious adverse events in R+FOLFIRI: hypertension gr4 (1 pt), gastrointestinal haemorrhage (1pt), gastrointestinal perforation gr 3 (1pt), death of stroke (1 pt) and gastrointestinal haemorrhage (1pt).Conclusion: docetaxel pre-treated pts seemed to derive pronounced benefit from FOLFIRI-Ram, providing a rationale for a phase III trial.

Keywords

• ramucirumab
• disseminated gastric cancer
• irinotecan
• folfiri
• paclitaxel
• docetaxel
• second line therapy