title: Ramucirumab for the treatment of gastroesophageal cancers.
abstract: BACKGROUND
  In 2014, the U.S. Food and Drug Administration (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.
  
  
  METHODS
  We briefly review the mechanisms of angiogenesis, anti-angiogenic therapy, and current status of advanced GEAC treatment then highlight the challenges and future prospects of novel molecular targeted agents.
  
  
  CONCLUSIONS
  Although both the REGARD and RAINBOW trials met their primary endpoints of significantly prolonged overall survival (OS) and progression-free survival (PFS), 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 (PK) 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.
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: Y
authors: Y
authors: Shimodaira
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: E
authors: E
authors: Elimova
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: R
authors: R
authors: Wadhwa
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: H
authors: H
authors: Shiozaki
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: N
authors: N
authors: Charalampakis
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: V
authors: V
authors: Planjery
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: J E
authors: JE
authors: Rogers
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: S
authors: S
authors: Song
authors: Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd, (FC10.3022), Houston, TX 77030, USA.
authors: J A
authors: JA
authors: Ajani