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SYSTEMATIC REVIEW article

Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1419338

Ramucirumab Plus FOLFIRI or Irinotecan as Second-Line Treatment for Patients with Gastroesophageal Adenocarcinoma: A Review and Meta-Analysis of an Emerging Option

Provisionally accepted
Haeseong Park Haeseong Park 1*Samuel J. Klempner Samuel J. Klempner 2Joseph Chao Joseph Chao 3Zev Wainberg Zev Wainberg 4Mariusz Lukanowski Mariusz Lukanowski 5Suresh Chenji Suresh Chenji 5Shannon Bourke Shannon Bourke 5Anindya Chatterjee Anindya Chatterjee 5Sylvie Lorenzen Sylvie Lorenzen 6
  • 1 Dana–Farber Cancer Institute, Boston, United States
  • 2 Massachusetts General Hospital, Boston, MA, United States
  • 3 City of Hope, Duarte, CA,, United States
  • 4 University of California, Los Angeles, Los Angeles, California, United States
  • 5 Eli Lilly and Company, Indianapolis, IN,, United States
  • 6 Technical University of Munich, Munich, Germany

The final, formatted version of the article will be published soon.

    The aim of this study was to provide a review of the clinical evidence for use of ramucirumab (RAM) plus folinic acid (leucovorin), fluorouracil (5-FU), and irinotecan (FOLFIRI) or irinotecan as second-line treatment in gastroesophageal adenocarcinoma (GEA). A systematic and comprehensive search of PubMed was performed to identify phase 2 clinical trials or retrospective studies using RAM plus FOLFIRI or irinotecan in GEA, including abstracts from major congresses, in addition to published manuscripts. An aggregated review and meta-analysis was performed to assess the effectiveness (overall response rate [ORR] as primary outcome) and safety data of RAM plus FOLFIRI or irinotecan. ORR for each study was calculated with 95% confidence interval estimated from normal approximation. To generate the combined ORR with 95% confidence interval, random-effects meta-analysis was conducted to synthesize response data from available studies. Six studies were identified with non-overlapping populations, 3 phase 2 clinical trials and 3 retrospective studies. Across these studies the ORR ranged from 22% to 38%, and pooled ORR was 25.4%. Two of the 3 studies reported better ORR in patients pretreated with taxanes followed by RAM plus FOLFIRI. Treatment with RAM plus FOLFIRI or irinotecan was well tolerated. Neutropenia and diarrhea were the most common adverse events reported across studies. The studies examined in this review suggest that RAM plus FOLFIRI or irinotecan have activity in previously treated GEA irrespective of prior-taxane use. Overall, RAM plus FOLFIRI or irinotecan was well tolerated with no new safety concerns identified beyond established profiles for these regimens.

    Keywords: Ramucirumab, Gastroesophageal adenocarcinoma, Second-line, irinotecan, FOLFIRI

    Received: 18 Apr 2024; Accepted: 22 Jul 2024.

    Copyright: © 2024 Park, Klempner, Chao, Wainberg, Lukanowski, Chenji, Bourke, Chatterjee and Lorenzen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Haeseong Park, Dana–Farber Cancer Institute, Boston, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.