title: Anti-angiogenic agent ramucirumab: meaningful or marginal?
abstract: Ramucirumab (IMC-1121B) targets VEGFR-2. Ramucirumab is being investigated in many malignancies including gastric cancer. The Phase III trial in patients with advanced breast cancer failed to improve the primary end point The REGARD trial, a Phase III study, in patients with advanced gastric cancer in the second line setting, had a marginal improvement in overall survival but did not achieve the expected hazard ratio target (of 0.69) and the median duration of therapy with ramucirumab was meager 8 weeks (only 2 weeks longer than the placebo's). Other notable agents in the second line setting are docetaxel and irinotecan. Preliminary results of the RAINBOW trial suggest that ramucirumab may be providing more than marginal advantage. In this review, we briefly summarize the process of angiogenesis and address the emerging cost-benefit issues that surround all newly developed agents including ramucirumab.
authors.affiliation: Department of GI Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd (FC10.3022), Houston, TX 77030, USA.
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Jeannelyn S
authors.initials: JS
authors.lastname: Estrella
authors.forename: Qiongrong
authors.initials: Q
authors.lastname: Chen
authors.forename: Shumei
authors.initials: S
authors.lastname: Song
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001943:Breast Neoplasms / Q000098:blood supply*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D017277:Drug Approval; D019008:Drug Resistance, Neoplasm; D006801:Humans; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D013274:Stomach Neoplasms / Q000098:blood supply*; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000037:antagonists & inhibitors; D000096662:Ramucirumab
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D040301:Vascular Endothelial Growth Factor Receptor-2; D000096662:Ramucirumab