Ramucirumab for the treatment of gastric adenocarcinoma

Introduction: Advanced gastric adenocarcinoma has a poor prognosis and palliative chemotherapy is the standard treatment option. However, novel approaches using targeted therapies have demonstrated significant improvements in survival rates. Among these novel molecules, ramucirumab has shown promising results, particularly in combination with paclitaxel, and has gained approval in several countries for advanced gastric adenocarcinoma. Areas covered: In this review, the authors discuss the therapeutic gap that ramucirumab is expected to fill compared to preexisting treatments, as well as data related to gastric adenocarcinoma epidemiology. A comprehensive description of the agent including history of ‘orphan status’, mechanism of action, chemistry, pharmacokinetics, and metabolism along with the clinical trials and data that led to the drug approval will also be presented. Finally, major topics of drug development in gastric adenocarcinoma will be discussed with analysis of current data, ongoing studies, and perspectives. The authors used PubMed database to identify relevant preclinical and clinical data and ClinicalTrials.gov for ongoing clinical trials. Expert opinion: Ramucirumab is adding value given its activity in multiple tumor types. The identification of predictive biomarkers will be an important step for individualization of treatment.