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Richard Kim, MD, assistant professor of oncology at University of South Florida College of Medicine, medical oncologist in the Department of Gastrointestinal Oncology at Moffitt Cancer Center, discusses the potential of ramucirumab in the treatment of advanced hepatocellular carcinoma.
Richard Kim, MD, assistant professor of oncology, University of South Florida College of Medicine, medical oncologist, Department of Gastrointestinal Oncology, Moffitt Cancer Center, discusses the potential of ramucirumab (Cyramza) in the treatment of patients with advanced hepatocellular carcinoma.
Ramucirumab is a VEGFR-2 monoclonal antibody that was studied in the randomized phase III REACH and REACH-2 trials. REACH was a negative study that compared ramucirumab to placebo in the second-line setting. However, when investigators looked at a subgroup analysis of patients who had alpha-fetoprotein (AFP) greater than 400 ng/mL, there appeared to be benefit with ramucirumab. This led to the REACH-2 study, which focused specifically on this patient population, Kim says.
REACH-2 was a positive study, showing an improvement in overall survival with ramucirumab in patients with AFP greater than 400 ng/mL. As a result, Kim believes the FDA will approve the drug in this setting. Notably, ramucirumab is monoclonal antibody, not a VEGF TKI, so there may be a more favorable toxicity profile. A portion of patients will fail frontline therapy, have AFP greater than 400 ng/mL, and will not be candidates for immunotherapy; these patients are likely to benefit from this therapy, Kim concludes.