Ramucirumab/Paclitaxel as Second-line Treatment in Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma With Integrative Genomic Analysis

NCT02628951 | Completed Phase 2

• 1 other identifier: 2015-11-110
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

Vascular endothelial growth factor is expressed in gastric cancer, and expression has been associated with more aggressive clinical disease. Vascular endothelial growth factor expression has been noted in 51% of gastric cancer specimens in one series (versus no expression in normal epithelium or superficial gastritis). Vascular endothelial growth factor expression in resected gastric cancer is associated with tumor recurrence and shorter survival. Maeda et al. studied 95 gastric cancer patients following resection with curative intent, and noted a significantly shorter survival in 34 patients whose tumor endothelium expressed VEGF (as detected via immunohistochemistry) versus 61 patients without endothelial VEGF expression (p\<0.05). Yoshikawa and colleagues observed similar survival differences in resected gastric cancer patients based on levels of circulating (plasma) VEGF at time of resection. Circulating VEGF is significantly higher in gastric cancer patients versus those without neoplasia. Elevated circulating VEGF was also associated with shorter survival in a European cohort undergoing gastric cancer resection; there was no survival beyond 30 months in 24 patients with serum VEGF \>533 pg/mL versus a 30-month survival rate \>35% for 34 patients with VEGF levels below this threshold (p\<0.0001, log-rank test). Recently, Jüttner and colleagues noted reduced survival following R0 resection in gastric cancer patients whose tumors expressed VEGF-C or VEGF-D, with the most robust association between expression and reduced survival for patients whose tumors expressed both VEGF-C and VEGF-D. Investigational inhibition of VEGF Receptor 2 in gastric cancer xenografts (TMK-1 cell line) is associated with reduced tumor growth. DC101 therapy in this model is associated with significant reductions in tumor vascularity (as measured by CD-31 expression) and increases in endothelial and tumor apoptosis. The results of the REGARD and RAINBOW studies are consistent with the idea that tumor- related angiogenesis contributes to the pathophysiology of gastric cancer and demonstrate the ability of ramucirumab to represent an improvement in the care of patients with gastric cancer whose disease has progressed after prior chemotherapy.

Conditions

Gastric Adenocarcinoma; Gastroesophageal Junction Adenocarcinoma

Outcome Measures

Primary Outcomes (1)

• objective response rate

  To evaluate response rate of Ramucirumab in combination with paclitaxel per RECIST 1.1

  every 6weeks

Secondary Outcomes (1)

• response rate according to molecular subtypes

  through study completion, an average of 1 year

Study Arms (1)

Ramucirumab + Paclitaxel

EXPERIMENTAL

Ramucirumab injection for intravenous (I.V.) use, supplied in single-use 500-mg/50-mL vials containing 10 mg/mL of product in histidine buffer, administered as an I.V. infusion after dilution at 8 mg/kg every 2 weeks in the absence of disease progression, toxicity requiring cessation, or withdrawal for any other reason. Paclitaxel will be administered at a dose of 80 mg/m2 on Days 1, 8 and 15 of a 28-day cycle in the absence of disease progression, toxicity requiring cessation, or withdrawal for any other reason.

Drug: Ramucirumab; Drug: Paclitaxel

Interventions

Ramucirumab DRUG

Ramucirumab injection for intravenous (I.V.) use, supplied in single-use 500-mg/50-mL vials containing 10 mg/mL of product in histidine buffer, administered as an I.V. infusion after dilution at 8 mg/kg every 2 weeks in the absence of disease progression, toxicity requiring cessation, or withdrawal for any other reason.

Ramucirumab + Paclitaxel

Paclitaxel DRUG

Paclitaxel will be administered at a dose of 80 mg/m2 on Days 1, 8 and 15 of a 28-day cycle in the absence of disease progression, toxicity requiring cessation, or withdrawal for any other reason.

Ramucirumab + Paclitaxel

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The patient has histologically or cytologically confirmed gastric carcinoma, including gastric adenocarcinoma or GEJ adenocarcinoma. (Patients with adenocarcinoma of the distal esophagus are eligible if the primary tumor involves the GEJ.)
• The patient has metastatic disease or locally recurrent, unresectable disease.
• The patient has measureable or evaluable disease as determined by standard computed tomography (CT) or magnetic resonance imaging (MRI) imaging. Examples of evaluable, nonmeasurable disease include gastric, peritoneal, or mesenteric thickening in areas of known disease, or peritoneal nodules that are too small to be considered measurable by Response Evaluation Criteria in Solid Tumors (RECIST version 1.1) (48).
• The patient has experienced disease progression during treatment or within 4 months after the last dose of first-line therapy for metastatic disease.
• Acceptable prior chemotherapy regimens for this protocol are combination chemotherapy regimens that include platinum and/or fluoropyrimidine components (acceptable prior platinum agents are cisplatin, carboplatin, or oxaliplatin; acceptable prior fluoropyrimidine agents are 5-FU, capecitabine, or S-1). Regimens including a third agent, such as an anthracycline or a taxane, are acceptable provided a fluoropyrimidine and/or a platinum were used.
• Recurrence during or within 6 months of completion of adjuvant chemotherapy (capecitabine, 5-FU, or TS-1) will be considered as first-line chemotherapy.
• The patient's disease is not amenable to potentially curative resection.
• The patient is ≥18 years of age.
• The patient has resolution to Grade ≤1 (or to Grade ≤2 in the case of neuropathy) by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI- CTCAE), Version 4.03, of all clinically significant toxic effects of prior chemotherapy, surgery, radiotherapy, or hormonal therapy (with the exception of alopecia).
• The patient has an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0 or 1.
• The patient has adequate hepatic function as defined by a total bilirubin ≤1.5 mg/dL (25.65 µmol/L), and aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3.0 times the upper limit of normal (ULN; or 5.0 times the ULN in the setting of liver metastases).
• The patient does not have:
• cirrhosis at a level of Child-Pugh B (or worse) or
• cirrhosis (any degree) and a history of hepatic encephalopathy or clinically meaningful ascites resulting from cirrhosis. Clinically meaningful ascites is defined as ascites from cirrhosis requiring diuretics or paracentesis.
• The patient has adequate renal function as defined by a serum creatinine ≤1.5 times the ULN, or creatinine clearance (measured via 24-hour urine collection) ≥40 mL/minute (that is, if serum creatinine is \>1.5 times the ULN, a 24-hour urine collection to calculate creatinine clearance must be performed).

You may not qualify if:

• The patient has documented and/or symptomatic brain or leptomeningeal metastases.
• The patient has experienced any Grade 3 to 4 GI bleeding within 3 months prior to enrollment.
• The patient has experienced any arterial thromboembolic events, including but not limited to myocardial infarction, transient ischemic attack, cerebrovascular accident, or unstable angina, within 6 months prior to enrollment.
• The patient has an ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, symptomatic or poorly controlled cardiac arrhythmia, uncontrolled thrombotic or hemorrhagic disorder, or any other serious uncontrolled medical disorders in the opinion of the treating physician.
• The patient has ongoing or active psychiatric illness or social situation that would limit compliance with treatment.
• The patient has uncontrolled or poorly controlled hypertension (\>160 mmHg systolic or \>100 mmHg diastolic for \>4 weeks) despite standard medical management.
• The patient has a serious or nonhealing wound, ulcer, or bone fracture within 28 days prior to enrollment.
• The patient has received chemotherapy, radiotherapy, immunotherapy, or targeted therapy for gastric cancer within 2 weeks prior to enrollment.
• The patient has received any investigational therapy within 30 days prior to enrollment.
• The patient has undergone major surgery within 28 days prior to enrollment, or subcutaneous venous access device placement within 7 days prior to enrollment.
• The patient has received prior therapy with an agent that directly inhibits VEGF (including bevacizumab), or VEGF Receptor 2 activity, or any antiangiogenic agent.
• The patient is receiving chronic antiplatelet therapy, including aspirin, nonsteroidal anti- inflammatory drugs (NSAIDs; including ibuprofen, naproxen, and others), dipyridamole or clopidogrel, or similar agents. Once-daily aspirin use (maximum dose 325 mg/day) is permitted.
• The patient has elective or planned major surgery to be performed during the course of the clinical trial.
• The patient has a known allergy to any of the treatment components.
• The patient is pregnant or breastfeeding.

Sponsors & Collaborators

• Samsung Medical Center: lead

Study Sites (1)

Samsung Medical Center

Seoul, 06351, South Korea

Location

Related Publications (1)

• Kim ST, Sa JK, Oh SY, Kim K, Hong JY, Kang WK, Kim KM, Lee J. Comprehensive molecular characterization of gastric cancer patients from phase II second-line ramucirumab plus paclitaxel therapy trial. Genome Med. 2021 Jan 25;13(1):11. doi: 10.1186/s13073-021-00826-w.

  PMID: 33494793 DERIVED

MeSH Terms

Interventions

Ramucirumab; Paclitaxel

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins; Taxoids; Cyclodecanes; Cycloparaffins; Hydrocarbons, Alicyclic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Diterpenes; Terpenes

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD,PhD,Division of hematology-oncology,Department of medicine

Study Record Dates

• First Submitted: December 6, 2015
• First Posted: December 11, 2015
• Study Start: May 26, 2016
• Primary Completion: January 2, 2019
• Study Completion: January 2, 2019
• Last Updated: November 19, 2020

Record last verified: 2020-11

Locations

KR (1)