Ramucirumab was approved by the US Food and Drug Administration for use as a single agent in the treatment of patients with advanced or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma with disease progression on or after treatment with fluoropyrimidine- or platinum-containing chemotherapy.1,2 Ramucirumab is a recombinant human IgG1 monoclonal antibody directed at vascular endothelial growth factor receptor 2 (VEGFR2). By binding VEGFR2, ramucirumab blocks binding of the VEGFR ligands VEGF-A, VEGF-C, and VEGF-D and thus inhibits ligand-stimulated activation of VEGFR2, including ligand-induced proliferation and migration of endothelial cells. Ramucirumab was shown to inhibit angiogenesis in vivo in animal models. The approval was based on the finding of improved overall survival (OS) in the international double-blind phase 3 REGARD trial (study I4T-IE-JVBD).2,3 Ramucirumab is the first biological treatment given as a single drug that has produced survival benefit in advanced gastric or GEJ adenocarcinoma progressing after first-line treatment, and the study findings validate VEGFR2 signaling as an important target in advanced gastric cancer.
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