Ramucirumab for the treatment of gastroesophageal cancers

Introduction: In 2014, the US FDA-approved ramucirumab for use in the second-line setting of advanced or metastatic, gastric or gastroesophageal adenocarcinoma (GEAC) based on the result of Phase III clinical trials; REGARD and RAINBOW.Areas covered: We briefly review the mechanisms of angiogenesis, antiangiogenic therapy and current status of advanced GEAC treatment then highlight the challenges and future prospects of novel molecular-targeted agents.Expert opinion: Although both the REGARD and RAINBOW trials met their primary end points of significantly prolonged overall survival and progression-free survival, the magnitude of the difference is still relatively modest. Given that ramucirumab alone has a marginal effect, a combination of paclitaxel and ramucirumab is strongly preferred as a second-line therapy. To maximize the impact of ramucirumab in patients with GEAC, we can leverage the recent pharmacokinetics data of ramucirumab from the REGARD and RAINBOW trials. In addition, the quest for identifying biomarkers to select patients who are likely to benefit the most should continue. It is our firm belief that taxanes should no longer be added to the frontline regimens in most cases, given the success of the taxane/ramucirumab in the second-line setting.