Abstract
Anti-vascular endothelial growth factor (VEGF) therapeutics such as bevacizumab, which are widely used in cancer treatment, commonly leads to hypertension. Moreover, bevacizumab-induced hypertension is associated with improved clinical outcomes in several cancers. We retrospectively analyzed 89 patients with histologically confirmed advanced gastric cancer who received the human monoclonal anti-VEGF receptor-2 antibody ramucirumab plus paclitaxel at our hospital between June 2015 and October 2016 to evaluate the impact of treatment-associated hypertension occurring within the first two treatment cycles (“early hypertension”) on outcome. The objective response rate was 40%, median progression-free survival was 5.4 months, and overall survival was 10.4 months, which is similar to previous reports. Early hypertension in patients who received more than two cycles of ramucirumab + paclitaxel was associated with longer progression-free and overall survival. Objective response rates were also higher in patients with early hypertension. These data indicate that early hypertension may be predictive of better outcomes in gastric cancer patients who receive ramucirumab + paclitaxel treatment.
Highlights
According to a recent survey by the National Cancer Center of Japan, gastric cancer is the second most commonly diagnosed malignant cancer and the third leading cause of cancer-related death in Japan [1]
Ramucirumab + paclitaxel treatment was associated with high efficacy and tolerability, which was similar to findings reported in the RAINBOW trial [8]
We found that the efficacy of ramucirumab + paclitaxel treatment was associated with treatmentrelated hypertension
Summary
According to a recent survey by the National Cancer Center of Japan, gastric cancer is the second most commonly diagnosed malignant cancer and the third leading cause of cancer-related death in Japan [1]. Metastatic, or advanced gastric cancer, fluoropyrimidine + platinum-based chemotherapy prolonged survival and improved quality of life (QOL) in several clinical trials [2,3,4,5]. The impact of second-line or salvage chemotherapy in gastric cancer patients has long been limited, taxanes and irinotecan are commonly used in East Asia [6]. In the RAINBOW trial, second-line treatment with ramucirumab in combination with paclitaxel prolonged overall survival (OS) and progression-free survival (PFS) compared to paclitaxel alone [8]. In the REGARD trial, second-line ramucirumab monotherapy improved OS and PFS compared to the placebo [9]. Ramucirumab has been approved as a second-line or later treatment for advanced gastric cancer in the U.S, Europe, and Japan
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