Paclitaxel and ramucirumab in advanced gastric or gastro-esophageal junction cancer

The new phase III ARMANI trial recently published on The Lancet Oncology shows that paclitaxel and ramucirumab switch maintenance could be a potential treatment strategy in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer.

For the ARMANI multicentre, open-label, randomised, phase 3 trial a total of 280 patients with locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction cancer, who had disease control after 3 months of FOLFOX (leucovorin, fluorouracil, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin), were enrolled. Patients were randomly assigned to receive a switch maintenance therapy with paclitaxel and ramucirumab or to continue chemotherapy for additional 12 weeks followed by fluoropyrimidine monotherapy maintenance (control group). At a median follow-up of 43·7 months 90% of 280 patients had a progression-free survival event (91% in the switch maintenance group and 90% in the control group). Median progression-free survival was 6,6 months in the switch maintenance group and 3,5 months in the control group; serious adverse events occurred in 20% of 141 patients in the experimental group and 11% of 135 patients in the control group, but they were treatment related in 1% of patients. As authors conclude, «Paclitaxel and ramucirumab switch maintenance could be a potential treatment strategy in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer who are not eligible for immunotherapy or targeted agents».