A Study of Ramucirumab (LY3009806) Versus Placebo in Participants With Hepatocellular Carcinoma and Elevated Baseline Alpha-Fetoprotein
REACH-2
Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study of Ramucirumab and Best Supportive Care (BSC) Versus Placebo and BSC as Second-Line Treatment in Patients With Hepatocellular Carcinoma and Elevated Baseline Alpha-Fetoprotein (AFP) Following First-Line Therapy With Sorafenib
3 other identifiers
interventional
399
19 countries
129
Brief Summary
The purpose of this study is to evaluate the safety and efficacy of ramucirumab in participants with hepatocellular carcinoma (HCC) and elevated baseline alpha-fetoprotein. Participants will be randomized to ramucirumab or placebo in a 2:1 ratio (Main Global Cohort and China Maximized Extended Enrollment \[MEE\] Cohort). Participants may also receive ramucirumab if eligible to be enrolled in Open-Label Expansion (OLE) Cohort.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for phase_3 hepatocellular-carcinoma
Started Jul 2015
Typical duration for phase_3 hepatocellular-carcinoma
129 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
May 1, 2015
CompletedFirst Posted
Study publicly available on registry
May 6, 2015
CompletedStudy Start
First participant enrolled
July 20, 2015
CompletedPrimary Completion
Last participant's last visit for primary outcome
March 15, 2018
CompletedResults Posted
Study results publicly available
May 17, 2019
CompletedStudy Completion
Last participant's last visit for all outcomes
November 19, 2021
CompletedJanuary 20, 2023
December 1, 2022
2.7 years
May 1, 2015
April 8, 2019
December 22, 2022
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Overall Survival (OS)
OS time was measured from date of randomization to date of death from any cause. Participants who were not known to have died on or before the date of data cut-off, OS data was censored on the last date (on or before the cut-off date) the participant was known to be alive.
From Date of Randomization to Death from Any Cause (Up to 28 Months)
Secondary Outcomes (9)
Progression Free Survival (PFS)
From Randomization to Objective Progression or Death from Any Cause (Up to 28 Months)
Time to Radiographic Progression
From Randomization to Objective Progression (Up to 28 Months)
Percentage of Participants With a Best Overall Response of Complete Response (CR) or Partial Response (PR): Objective Response Rate (ORR)
From Randomization to Objective Progression (Up to 28 Months)
Pharmacokinetics (PK): Minimum Serum Concentration (Cmin) Before 2nd, 4th, 7th, and 10th Infusion
Predose, Weeks 2, 6, 12 and 18, Day 1; Up to 3 Days Before Infusion (14-Day Cycles)
PK: Serum Concentration Maximum (Cmax) After 1st, 2nd, 4th, 7th and 10th Ram Infusion
Weeks 0, 2, 6, 12 and 18, Day 1; 1 hour to 1.5 hours Post End of Infusion (14 day-Cycles)
- +4 more secondary outcomes
Study Arms (5)
Ramucirumab + Best Supportive Care (BSC)
EXPERIMENTAL8 milligrams per kilogram (mg/kg) ramucirumab administered as an intravenous (IV) injection on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.
Placebo + BSC
PLACEBO COMPARATORPlacebo administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.
Open Label Ramucirumab + BSC
EXPERIMENTAL8 mg/kg ramucirumab administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.
Ramucirumab MEE Cohort + BSC
EXPERIMENTAL8 mg/kg ramucirumab administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.
Placebo MEE Cohort + BSC
PLACEBO COMPARATORPlacebo administered IV on day 1 of each 14 day cycle. Participants may continue treatment until discontinuation criteria are met.
Interventions
Administered IV
Eligibility Criteria
You may qualify if:
- A diagnosis of HCC based on histopathologic findings, or a diagnosis of cirrhosis and a tumor with classical HCC imaging characteristics.
- Sorafenib was the only systemic therapy for HCC and was discontinued for disease progression or intolerance (Main Global and MEE Cohorts only).
- The participant received ≤2 prior systemic therapy regimen, excluding prior sorafenib or chemotherapy, for the treatment of HCC (OLE Cohort only).
- ≥1 measurable lesion per Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1 that has not been previously treated with locoregional therapy. A participant with a lesion(s) that has previously been treated with locoregional therapy is also eligible, if the lesion has documented progression after locoregional treatment and is measureable.
- Child-Pugh score \<7 (Child-Pugh Class A).
- Barcelona Clinic Liver Cancer (BCLC) Stage C disease or BCLC Stage B disease not amenable to locoregional therapy or refractory to locoregional therapy.
- Baseline AFP ≥400 nanograms/milliliter.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Resolution of all clinically significant toxic effects of prior therapy.
- Total bilirubin ≤1.5 times upper limit of normal value (ULN), aspartate transaminase (AST) and alanine transaminase (ALT) ≤5 × ULN.
- Creatinine clearance ≥60 milliliters/minute.
- Urinary protein is ≤1+ on dipstick or routine urinalysis or 24-hour urine demonstrating \<1 gram of protein.
- Absolute neutrophil count ≥1.0 × 10\^9/Liter, hemoglobin ≥9 grams/deciliter, and platelets ≥75 × 10\^9/Liter.
- International Normalized Ratio (INR) ≤1.5 and a partial thromboplastin time (PTT) ≤5 seconds above the ULN.
- Surgically sterile, postmenopausal, or compliant with a highly effective contraceptive method.
- +2 more criteria
You may not qualify if:
- Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma.
- Concurrent malignancy. Participants with carcinoma in situ of any origin and participants with prior malignancies in remission may be eligible with sponsor approval.
- Previous brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
- History of or current hepatic encephalopathy or clinically meaningful ascites.
- Ongoing or recent hepatorenal syndrome.
- Liver transplant (Main Global and MEE cohorts only; Participants with prior liver transplant may be eligible for OLE cohort).
- Hepatic locoregional therapy following prior systemic therapy or within 28 days prior to randomization.
- Major surgical procedure, traumatic injury, non-healing wound, or peptic ulcer ≤28 days prior to randomization.
- Received radiation to any nonhepatic (for example, bone) site within 14 days prior to randomization.
- Placement of a subcutaneous venous access device within 7 days prior to the first dose of study treatment unless the procedure is judged of low risk of bleeding.
- Enrolled in a clinical trial involving an investigational product or unapproved use of a drug or in medical research judged not to be scientifically or medically compatible with this study.
- Discontinued from study treatment from another clinical trial within 28 days prior to randomization.
- Known allergy to any of the treatment components.
- Uncontrolled hypertension.
- Any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack, \<6 months prior to randomization.
- +18 more criteria
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (131)
Pacific Hematology and Oncology Associates
Daly City, California, 94115, United States
UCLA Medical Center
Los Angeles, California, 90024, United States
Georgetown University Medical Center
Washington D.C., District of Columbia, 20007, United States
University of Iowa Hospital
Iowa City, Iowa, 52242, United States
Massachusetts General Hospital
Boston, Massachusetts, 02114, United States
Mount Sinai Medical Center
New York, New York, 10029, United States
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104, United States
OREGON HEALTH and SCIENCE UNIVERSITY
Portland, Oregon, 97239, United States
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Kurralta Park, 5037, Australia
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Woodville, 5011, Australia
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Linz, 4020, Austria
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Vienna, 1090, Austria
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Brussels, 1200, Belgium
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Liège, 4000, Belgium
Fundação PIO XII
Barretos, 14784-400, Brazil
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Barretos, 14784700, Brazil
Cenantron - Centro Avançado de Tratamento Oncológico
Belo Horizonte, 30130-090, Brazil
Associação Hospital de Caridade Ijuí
Ijuí, 98700 000, Brazil
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Porto Alegre, 90470-340, Brazil
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São Paulo, 04039-901, Brazil
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Montreal, H2X 3E4, Canada
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Toronto, M5G 2M9, Canada
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Beijing, 100032, China
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Beijing, 100142, China
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Beijing, China
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Beijing, China
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Changsha, 410011, China
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Changsha, 410013, China
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Chongqing, 400038, China
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Guangdong, 510515, China
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Guangzhou, 510080, China
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Hangzhou, 310003, China
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Hangzhou, 310009, China
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Hangzhou, 310022, China
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Hebei, 050011, China
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Hefei, 230022, China
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Heilongjiang, 150081, China
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Henan, 450008, China
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Hubei, 56456, China
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Nanjing, 210002, China
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Nanjing, 210006, China
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Nanning, 530021, China
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Qingdao, 266003, China
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Shanghai, 200030, China
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Shanghai, 200127, China
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Shanghai, China
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Shanghai, China
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Shenyang, 100042, China
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Wuhan, 430030, China
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Xi'an, 710032, China
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Brno, 656 53, Czechia
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Prague, 150 06, Czechia
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Amiens, 80054, France
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Avignon, 84918, France
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Besançon, 25030, France
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Caen, 14033, France
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Clermont-Ferrand, 63003, France
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Lyon, 69317, France
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Montpellier, 34295, France
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Nantes, 44093, France
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Pessac, 33604, France
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Rennes, 35042, France
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Saint-Etienne, 42000, France
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Bayern, 81377, Germany
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Berlin, 13125, Germany
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Essen, 45122, Germany
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Frankfurt, 60590, Germany
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Hamburg, 20246, Germany
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Hanover, 30625, Germany
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Leipzig, 04103, Germany
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Magdeburg, 39120, Germany
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Mainz, 55131, Germany
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München, 81675, Germany
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Tübingen, 72076, Germany
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Hong Kong, Hong Kong
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Hong Kong, Hong Kong
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Kowloon, Hong Kong
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Shatin, Hong Kong
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Tuenmen, Hong Kong
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Haifa, 3109601, Israel
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Tel Aviv, 6423906, Israel
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Benevento, 82100, Italy
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Bologna, 40138, Italy
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Cremona, 26100, Italy
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Padua, 35128, Italy
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Rome, 00168, Italy
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Chūōku, 104-0045, Japan
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Fukuoka, 810-8563, Japan
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Fukuoka, 811-1395, Japan
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Iizuka, 820-8505, Japan
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Kanazawa, 920-8641, Japan
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Kashiwa, 277 8577, Japan
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Kyoto, 606-8507, Japan
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Matsuyama, 791-0280, Japan
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Osaka, 589-8511, Japan
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Ōsaka, 541-8567, Japan
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Shimotsuke, 329-0498, Japan
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Suita-shi, 565-0871, Japan
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Sunto-Gun, 411-8777, Japan
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Tokyo, 101-0062, Japan
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Yokohama, 241-8515, Japan
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Gdansk, 80-219, Poland
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Poznan, 61-866, Poland
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Warsaw, 01-748, Poland
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Incheon, 21565, South Korea
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Seoul, 03080, South Korea
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Seoul, 03722, South Korea
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Seoul, 05505, South Korea
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Seoul, 06351, South Korea
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Ulsan, 44033, South Korea
Hospital Universitari de Girona Dr. Josep Trueta
Girona, 17007, Spain
Hospital Clínico San Carlos
Madrid, 28040, Spain
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Santander, 39008, Spain
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Valencia, 46026, Spain
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Bern, 3010, Switzerland
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Buzi, 61363, Taiwan
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Kaohsiung City, 83301, Taiwan
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Taichung, 40705, Taiwan
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Tainan, 704, Taiwan
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Tainan, 71004, Taiwan
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Tainan, 736, Taiwan
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Taipei, 10048, Taiwan
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Taipei, 11217, Taiwan
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Taoyuan, 33305, Taiwan
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Acton, W12 0HS, United Kingdom
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Acton, w120hs, United Kingdom
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Bebington, CH63 4JY, United Kingdom
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Birmingham, B15 2TH, United Kingdom
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London, NW3 2QG, United Kingdom
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London, SE5 9RS, United Kingdom
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Manchester, M20 4BX, United Kingdom
Related Publications (9)
Shao G, Bai Y, Yuan X, Chen X, Gu S, Gu K, Hu C, Liang H, Guo Y, Wang J, Yen CJ, Lee VH, Wang C, Widau RC, Zhang W, Liu J, Zhang Q, Qin S. Ramucirumab as second-line treatment in Chinese patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein after sorafenib (REACH-2 China): A randomised, multicentre, double-blind study. EClinicalMedicine. 2022 Oct 6;54:101679. doi: 10.1016/j.eclinm.2022.101679. eCollection 2022 Dec.
PMID: 36247923DERIVEDLlovet JM, Singal AG, Villanueva A, Finn RS, Kudo M, Galle PR, Ikeda M, Callies S, McGrath LM, Wang C, Abada P, Widau RC, Gonzalez-Gugel E, Zhu AX. Prognostic and Predictive Factors in Patients with Advanced HCC and Elevated Alpha-Fetoprotein Treated with Ramucirumab in Two Randomized Phase III Trials. Clin Cancer Res. 2022 Jun 1;28(11):2297-2305. doi: 10.1158/1078-0432.CCR-21-4000.
PMID: 35247922DERIVEDMitani S, Chen Y, Inoue K, Mori J, Gao L, Long A, Wakabayashi S. Clinical Impact of a Shortened Infusion Duration of Ramucirumab in Japanese Patients -A Model-Based Approach. Gan To Kagaku Ryoho. 2021 Nov;48(11):1381-1387.
PMID: 34795131DERIVEDTrojan J, Mollon P, Daniele B, Marteau F, Martin L, Li Y, Xu Q, Piscaglia F, Zaucha R, Sarker D, Lim HY, Venerito M. Comparative Efficacy of Cabozantinib and Ramucirumab After Sorafenib for Patients with Hepatocellular Carcinoma and Alpha-fetoprotein >/= 400 ng/mL: A Matching-Adjusted Indirect Comparison. Adv Ther. 2021 May;38(5):2472-2490. doi: 10.1007/s12325-021-01700-2. Epub 2021 Apr 6.
PMID: 33822328DERIVEDZhu AX, Finn RS, Kang YK, Yen CJ, Galle PR, Llovet JM, Assenat E, Brandi G, Motomura K, Ohno I, Daniele B, Vogel A, Yamashita T, Hsu CH, Gerken G, Bilbruck J, Hsu Y, Liang K, Widau RC, Wang C, Abada P, Kudo M. Serum alpha-fetoprotein and clinical outcomes in patients with advanced hepatocellular carcinoma treated with ramucirumab. Br J Cancer. 2021 Apr;124(8):1388-1397. doi: 10.1038/s41416-021-01260-w. Epub 2021 Feb 3.
PMID: 33531690DERIVEDReig M, Galle PR, Kudo M, Finn R, Llovet JM, Metti AL, Schelman WR, Liang K, Wang C, Widau RC, Abada P, Zhu AX. Pattern of progression in advanced hepatocellular carcinoma treated with ramucirumab. Liver Int. 2021 Mar;41(3):598-607. doi: 10.1111/liv.14731. Epub 2020 Dec 5.
PMID: 33188713DERIVEDZhu AX, Nipp RD, Finn RS, Galle PR, Llovet JM, Blanc JF, Okusaka T, Chau I, Cella D, Girvan A, Gable J, Bowman L, Wang C, Hsu Y, Abada PB, Kudo M. Ramucirumab in the second-line for patients with hepatocellular carcinoma and elevated alpha-fetoprotein: patient-reported outcomes across two randomised clinical trials. ESMO Open. 2020 Aug;5(4):e000797. doi: 10.1136/esmoopen-2020-000797.
PMID: 32817068DERIVEDKudo M, Okusaka T, Motomura K, Ohno I, Morimoto M, Seo S, Wada Y, Sato S, Yamashita T, Furukawa M, Aramaki T, Nadano S, Ohkawa K, Fujii H, Kudo T, Furuse J, Takai H, Homma G, Yoshikawa R, Zhu AX. Ramucirumab after prior sorafenib in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein: Japanese subgroup analysis of the REACH-2 trial. J Gastroenterol. 2020 Jun;55(6):627-639. doi: 10.1007/s00535-020-01668-w. Epub 2020 Feb 27.
PMID: 32107609DERIVEDZhu AX, Kang YK, Yen CJ, Finn RS, Galle PR, Llovet JM, Assenat E, Brandi G, Pracht M, Lim HY, Rau KM, Motomura K, Ohno I, Merle P, Daniele B, Shin DB, Gerken G, Borg C, Hiriart JB, Okusaka T, Morimoto M, Hsu Y, Abada PB, Kudo M; REACH-2 study investigators. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased alpha-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019 Feb;20(2):282-296. doi: 10.1016/S1470-2045(18)30937-9. Epub 2019 Jan 18.
PMID: 30665869DERIVED
Related Links
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Results Point of Contact
- Title
- Chief Medical Officer
- Organization
- Eli Lilly and Company
Study Officials
- STUDY DIRECTOR
Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern Time (UTC/GMT - 5 hours EST)
Eli Lilly and Company
Publication Agreements
- PI is Sponsor Employee
- No
- Restriction Type
- GT60
- Restrictive Agreement
- Yes
Study Design
- Study Type
- interventional
- Phase
- phase 3
- Allocation
- RANDOMIZED
- Masking
- DOUBLE
- Who Masked
- PARTICIPANT, INVESTIGATOR
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- INDUSTRY
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
May 1, 2015
First Posted
May 6, 2015
Study Start
July 20, 2015
Primary Completion
March 15, 2018
Study Completion
November 19, 2021
Last Updated
January 20, 2023
Results First Posted
May 17, 2019
Record last verified: 2022-12-01
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, SAP, CSR
- Time Frame
- Data are available 6 months after the primary publication and approval of the indication studied in the US and EU, whichever is later. Data will be indefinitely available for requesting.
- Access Criteria
- A research proposal must be approved by an independent review panel and researchers must sign a data sharing agreement.
Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.