O-0006 - RAINBOW: a global, phase 3, double-blind study of ramucirumab plus paclitaxel versus placebo plus paclitaxel in the treatment of gastric cancer foll...

Date 26 June 2014
Event World GI 2014
Session Gastric cancer
Topics Anti-Cancer Agents & Biologic Therapy
Gastric Cancer
Presenter Hansjochen Wilke
Citation Annals of Oncology (2014) 25 (suppl_2): ii105-ii117. 10.1093/annonc/mdu193
Authors H. Wilke1, P. Clingan2, S. Ananda3, G. Kurteva4, T. Suuroja5, G. Folprecht6, A. Beny7, D. Pastorelli8, A. Cesas9, C. Toganel10, O. Lipatov11, M. Limon12, S. Cummins13, A. Ko14, M. Emig15, K. Chandrawansa16
  • 1Kliniken-Essen-Mitte, Essen/DE
  • 2Southern Medical Day Care Centre, Wollongong/AU
  • 3Royal Melbourne Hospital, Parkville/AU
  • 4Specialised Hospital for Active Treatment in Oncology, Sofia/BG
  • 5North Estonia Medical Centre, Tallinn/EE
  • 6University Hospital Carl Gustav Carus, Dresden/DE
  • 7Rambam Medical Center, Haifa/IL
  • 8Istituto Oncologico Veneto (IOV) – IRCCS, Padova/IT
  • 9Klaipéda University Hospital, Klaipeda/LT
  • 10Spitalul Clinic Judetean Mures, Targu Mures/RO
  • 11Republican Clinical Oncology Dispensary, Ufa/RU
  • 12H.U.V. del Rocío, Sevilla/ES
  • 13St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford/UK
  • 14UCSF Comprehensive Cancer Center, San Francisco/US
  • 15Lilly Deutschland GmbH, Bad Homburg/DE
  • 16Eli Lilly, Bridgewater/US

Abstract

Introduction

RAINBOW, a global, placebo-controlled, double-blind, phase III trial, demonstrated significant improvements in overall survival (OS) (hazard ratio (HR) 0.807; 95% CI 0.678, 0.962; p = 0.0169), progression-free survival (PFS) (HR 0.635; 95%CI 0.536, 0.752; p < 0.0001), and response rates (ORR 27.9% RAM + PTX;16.1 PTX p= 0.0001) in advanced gastric or GEJ adenocarcinoma patients receiving ramucirumab (RAM), a human IgG1 VEGF receptor 2 targeted antibody, plus paclitaxel (PTX). We present the pre-planned subgroup analysis of Western patients (Region 1).

Methods

Pts received RAM (8 mg/kg IV q2w) or placebo (PL) plus PTX (80 mg/m2 d1, 8, 15 of a 4 week cycle) until disease progression, unacceptable toxicity, or until other discontinuation criteria were met. Eligible pts had ECOG PS ≤ 1 and adequate organ function. Randomisation was stratified by geographic region (Region 1: Europe (including Israel), Australia, and United States, Region 2: Argentina, Brazil, Chile, and Mexico, and Region 3: Japan, South Korea, Hong Kong, Singapore, and Taiwan), time to progression after first dose of first line therapy (< 6 months vs ≥ 6 months), and disease measurability (measurable vs. nonmeasurable). OS and PFS were compared between treatment arms using a stratified log-rank test. ORR was analyzed using a CMH test.

Results

Of the 665 worldwide patients, 398 Western patients (Europe including Israel, US, AUS) were randomized (RAM + PTX: 198; PTX: 200). Baseline characteristics were generally balanced between arms. The OS Hazard Ratio (HR) was 0.726 (95% CI 0.580, 0.909; p = 0.0050). Median OS was 8.57m for RAM + PTX and 5.91m for PTX. The HR for PFS was 0.631 (95% CI 0.506, 0.786; p < 0.0001). Median PFS was 4.24 m and 2.83 m. Median TTP was 5.36 m RAM + PTX; 3.15 m PTX (p = 0.0002). ORR was 26.8% RAM + PTX; 13.0% PTX (p = 0.0004). Grade ≥ 3 adverse events (AEs) occurring in >5% of patients on RAM + PTX were: neutropenia (32.1% vs. 14.7%), hypertension (17.9% vs. 2.0%), leukopenia (9.7% vs. 4.1%), fatigue (10.2% vs. 5.1%), asthenia (7.7% vs. 2.0%), anemia (6.6% vs. 6.1%), abdominal pain (6.6% vs. 4.6%), and general physical health deterioration (5.6% both arms).

Conclusion

In the Western population of the RAINBOW study, the significant benefits observed in OS, PFS, and ORR were consistent with those in the overall ITT population. The adverse event profile was similar to the overall population with neutropenia, hypertension, leukopenia and fatigueasthenia more frequently reported in the RAM + PTX arm.