Ramucirumab combined with FOLFOX as front-line therapy for advanced esophageal, gastroesophageal junction, or gastric adenocarcinoma: a randomized, double-blind, multicenter Phase II trial

Harry H Yoon, J. C. Bendell, F. S. Braiteh, I. Firdaus, P. A. Philip, A. L. Cohn, N. Lewis, D. M. Anderson, E. Arrowsmith, J. D. Schwartz, L. Gao, Y. Hsu, Y. Xu, D. Ferry, Steven Robert Alberts, Z. A. Wainberg

Research output: Contribution to journalArticle

60 Scopus citations


BACKGROUND: We report the first randomized, Phase II trial of ramucirumab, an anti-vascular endothelial growth factor receptor-2 monoclonal antibody, as front-line therapy in patients with advanced adenocarcinoma of the esophagus or gastric/gastroesophageal junction (GEJ).

PATIENTS AND METHODS: Patients from the USA with advanced esophageal, gastric, or GEJ adenocarcinoma randomly received (1:1) mFOLFOX6 plus ramucirumab (8 mg/kg) or mFOLFOX6 plus placebo every 2 weeks. The primary end point was progression-free survival (PFS) with 80% power to detect a hazard ratio (HR) of 0.71 (one-sided α = 0.15). Secondary end points included evaluation of response and overall survival (OS); an exploratory ramucirumab exposure-response analysis was undertaken.

RESULTS: Of 168 randomized patients, 52% of tumors were located in the stomach/GEJ and 48% in the esophagus. The trial did not meet the primary end point of PFS [6.4 versus 6.7 months, HR 0.98 (95% confidence interval 0.69-1.37)] or the secondary end point of OS (11.7 versus 11.5 months) in the intent-to-treat (ITT) population. Objective response rates (45.2% versus 46.4%) were similar between arms. Most Grade ≥3 toxicities did not differ significantly between arms, yet premature discontinuation of FOLFOX and ramucirumab (for reasons other than progressive disease) was more common among ramucirumab- versus placebo-treated patients. In an exploratory analysis that censored for premature discontinuation, the HR for PFS favored the ramucirumab arm (HR 0.76), particularly in patients with gastric/GEJ cancer. An exploratory exposure-response analysis indicated that patients with higher ramucirumab exposure had longer OS.

CONCLUSION: The addition of ramucirumab to front-line mFOLFOX6 did not improve PFS in the ITT population.


Original languageEnglish (US)
Pages (from-to)2196-2203
Number of pages8
JournalAnnals of oncology : official journal of the European Society for Medical Oncology
Issue number12
StatePublished - Dec 1 2016



  • esophageal cancer
  • gastric cancer
  • gastroesophageal junction
  • ramucirumab
  • vascular endothelial growth factor

ASJC Scopus subject areas

  • Hematology
  • Oncology

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