Multicentre, double-blind, randomised Phase II study evaluating gemcitabine with or without Ramucirumab as II line treatment for MPM

Date 20 October 2018
Event ESMO 2018 Congress
Session Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Topics Mesothelioma
Presenter Maria Pagano
Citation Annals of Oncology (2018) 29 (suppl_8): viii641-viii644. 10.1093/annonc/mdy301
Authors M. Pagano1, F. Zanelli1, R. Gnoni1, C. Bonelli1, M. Tiseo2, L. Boni3, G.L. Ceresoli4, P.A. Zucali5, F. Grosso6, G. Pasello7, F. Cappuzzo8, C. Pinto1
  • 1Oncology Unit, AUSL-IRCCS Reggio Emilia, 42100 - Reggio Emilia/IT
  • 2Medical Oncology, AOU di Parma, 43126 - Parma/IT
  • 3Istituto Toscano Tumori, clinical trial coordinating center, AOU careggi ,, firenze/IT
  • 4Oncology Unit, Humanitas Gavazzeni, 24125 - Bergamo/IT
  • 5Uo Oncologia Medica E Ematologia, Humanitas Cancer Center Istituto Clinico Humanitas - IRCCS, 20089 - Rozzano/IT
  • 6Oncology Unit, Ospedale di Alessandria, 15121 - Alessandria/IT
  • 7Oncology Unit, Istituto Oncologico Veneto IRCCS, 35128 - Padova/IT
  • 8Oncology Unit, Ospedale Civile di Ravenna - S.ta Maria delle Croci, 48121 - Ravenna/IT



Malignant Pleural Mesothelioma (MPM) is still a fatal cancer and median overall survival is still approximately 1 year after diagnosis and new therapies are being awaited. After first line therapy patients inevitably progress and usually they are in good conditions and inquire about a second-line treatment. Even if a second line therapy is frequently considered in common clinical practice, the optimal treatment has not been defined yet. Gemcitabine was largely used in association with platinum compounds before the registration of platinum-pemetrexed doublet in first line setting. Pre-clinical data suggest the importance of angiogenesis in tumour biology of MPM. Considering the documented high VEGFR-2 expression in MPM and the high affinity of ramucirumab for the same receptor, and given the failure of previous anti-angiogenetic drugs as single agent, we hypothesised a significant activity of ramucirumab in MPM in association with gemcitabine.

Trial design

RAMES is a multicentre, double-blind, randomised Phase 2 study,to evaluate the efficacy and the safety of the addition of ramucirumab to gemcitabine as the second-line treatment of patients with MPM.Randomisation will be done via a centralized system and will stratified by performance status (0-1 vs 2) age (≤70 vs > 70) histology (epithlioid vs others) and time to progression after first line therapy (< 6 months vs ≥ 6 months).The primary objective is overall survival. Secondary objectives are progression free survival and safety. Patients will be randomly assigned (1:1) to receive intravenous gemcitabine (1000 mg/mq) on days 1 and 8 every 21 days with placebo or combined with intravenous ramucirumab 10 mg/kg (ramucirumab group) on day 1 of a 21-day cycle until progression disease or unacceptable toxicity. The interim analysis was performed 6 weeks after enrolment of the 80th patient. Blood samples were collected for pharmacokinetic and immunogenic analyses. The study duration will be 24 months for the accrual. The great amount of interest and the scarce availability of ongoing trials have made recruitment rapid. This will allow information on the possible benefit of ramucirumab in MPM to be given much earlier than expected.

Clinical trial identification

EudraCT: 2016-001132-36.

Legal entity responsible for the study

AUSL-IRCCS Reggio Emilia.


Has not received any funding.

Editorial Acknowledgement


All authors have declared no conflicts of interest.