Ramucirumab: A New Therapy for Advanced Gastric Cancer

© 2015 Harborside Press® Gastric cancer is the fourth most common cancer in men and the fifth most common cancer in women worldwide (Jemal et al., 2011). The American Cancer Society (ACS) has estimated there were 22,220 new cases diagnosed in 2014, with an estimated 10,990 deaths (Siegel, Ma, Zou, & Jemal, 2014). Despite some advances in treatment, gastric cancer continues to be associated with poor outcomes. Approximately two-thirds of patients diagnosed with gastric cancer have locally advanced or metastatic disease, with a median survival of around 10 months (Chau et al., 2004). Chemotherapy is the primary modality for management of advanced and metastatic gastric cancers and has been shown to improve quality of life and prolong survival (Wagner et al., 2006). The standard of care for treatment of advanced disease is poorly defined, with no preferred firstor second-line regimens. Category 1 recommendations for first-line therapy for locally advanced and metastatic disease include a twodrug regimen of cisplatin combined with a fluoropyrimidine (fluorouracil or capecitabine) or cisplatin and a fluoropyrimidine combined with a third agent, which is typically epirubicin or docetaxel. Two-drug regimens are generally preferred, since they are associated with less toxicity (National Comprehensive Cancer Network [NCCN], 2014). Prior to 2014, there were no category 1 recommendations for secondline therapy for gastric cancer. The decision to give second-line therapy was generally based on the patient’s performance status and prior therapy exposure. Preferred regimens included single-agent irinotecan or taxane (docetaxel or paclitaxel; NCCN, 2014). The development of new therapies offers viable treatment options for patients with advanced and metastatic disease.