Abstract: Gastric cancer is the sixth most common cancer and is known to be the fifth-leading cause of cancer-related deaths globally in 2018. Systemic therapy remains the only curative option in advanced gastric carcinoma with the primary goal of improving the Health-related Quality of Life (HRQoL) (including palliation of symptoms such as dysphagia) and prolonging overall survival. Recently, ramucirumab is approved by the United States Food and Drug Administration (US-FDA) as a second-line agent either as monotherapy or in combination with paclitaxel in advanced or metastatic gastric and gastro-esophageal junction adenocarcinoma patients who have progressed on prior treatment with fluoropyrimidine or platinum containing chemotherapy. HRQoL is a subjective term that typically constitutes four components – psychological, social, occupational and physical well being. This has been evaluated as secondary endpoint in the pivotal Phase III trials with ramucirumab. HRQoL measurement can potentially provide additional information for clinical decision making beyond that of traditional medical outcomes. The present work is primarily focused on discussing HRQoL in gastric cancer patients and the impact of ramucirumab on the HRQoL in the patients with advanced gastric cancer. We also summarized the studies that evaluated the benefits of systemic therapies on HRQoL in advanced gastric cancer.

Keywords: ramucirumab, gastric cancer, gastroesophageal junction cancer, quality of life

INTRODUCTION

Gastric cancer is the sixth most common cancer and is known to be fifth-leading cause of cancer-related deaths globally in 2018.¹ Systemic therapy remains the only curative option in advanced gastric carcinoma with the primary goal of improving the Health- related Quality of Life (HRQoL) (including palliation of symptoms such as dysphagia) and prolonging overall survival (OS). Fluoropyrimidines in combination with platinum agents remain as preferred first line therapy in non-HER2 positive gastric adenocarcinomas.² In tumors that are highly positive for HER2 (3+ on immunohistochemical staining) or positive of florescent-in situ hybridization (FISH), a combination of chemotherapy and trastuzumab is the standard of care.²

Ramucirumab, a fully monoclonal IgG1 antibody targeting Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) is approved by the United States Food and Drug Administration (US-FDA) as a second-line agent either as monotherapy or in combination with paclitaxel in advanced or metastatic gastric and gastro-esophageal junction (GEJ) adenocarcinoma patients who have progressed on prior treatment with fluoropyrimidine or platinum containing chemotherapy, based on the results of two phase III trials (REGARD, RAINBOW). In the REGARD trial, ramucirumab was compared to best supportive care alone in 355 gastric and GEJ cancer patients who had progressed on prior fluoropyrimidine or platinum-containing regimen. The median OS was 5.2 months as compared to 3.8 months in those in the placebo group.³ In the RAINBOW trial, the combination of ramucirumab and paclitaxel was compared against paclitaxel alone in 665 patients with gastric and GEJ cancer after progression on first line treatment. The OS was significantly longer in the combination arm (9.6 months) as compared to the paclitaxel alone arm (7.4 months)⁴

However, even with improvement in OS, we are not curing most of advanced gastric cancer patients leading to more awareness about HRQoL. The present work is primarily focused on discussing HRQoL in gastric cancer patients and the impact of ramucirumab on the HRQoL in the patients with advanced gastric cancer. We also summarized the studies that evaluated the benefits of systemic therapies on HRQoL in advanced gastric cancer.

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