CC BY-NC-ND 4.0 · South Asian J Cancer
DOI: 10.1055/s-0041-1728980
Original Article

Ramucirumab in Indian Patients with Advanced Gastric Cancer—Does Borderline Performance Status and Heavy Burden of Disease in Real World Practice Impact Clinical Benefit?

Anant Ramaswamy
1  Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
,
Kripa Bajaj
1  Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
,
Vineet Talwar
2  Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
,
Kumar Prabhash
1  Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
,
Ullas Batra
2  Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
,
Boman Dhabhar
3  Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
,
Mansi Sharma
2  Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
,
Nikhil Ghadyalpatil
4  Yashoda Cancer Institute, Somajiguda Hyderabad, India
,
Satish CT
5  HCG Group of Hospital, Bangalore, Karnataka, India
,
Gautam Goyal
6  Department of Oncology, Max Super Speciality Hospital, Mohali, Punjab, India
,
Javvid Muzamil
7  Department of Medical Oncology, Khyber Superspeciality Institute, Srinagar, Kashmir, J&K, India
,
Amit Bhatt
8  Avinash Cancer Clinic, Pune, Maharashtra, India
,
Parveen Jain
2  Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
,
Anantbhushan Ranade
8  Avinash Cancer Clinic, Pune, Maharashtra, India
,
Mangesh Kamath
9  Gleneagles Global Hospital, Bengaluru, Karnataka, India
,
Jayant Pundlik Gawande
10  Aditya Birla Memorial Hospital, Aditya Birla Hospital Marg, Chinchwad, Pune, Maharashtra, India
,
Ravi Thippeswamy
11  Sri Shankara Cancer Hospital Basavangudi, Bangalore, Karnataka, India
,
Jimmy Mirani
3  Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
,
Neelesh Reddy
12  Columbia Asia Hospital Yeshwantpur, Bangalore, Karnataka, India
,
Sandip Ganguly
13  Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
,
Sourav Kumar Mishra
14  Department of Medical Oncology, SUM Hospitals, Bhubaneswar, Odisha, India
,
Irappa Madabhavi
15  Halamma Kerudi Cancer Hospital, Bagalkot, Karnataka, India
,
Shashidhara HP
5  HCG Group of Hospital, Bangalore, Karnataka, India
,
Soumya Surath Panda
16  Department of Medical Oncology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
,
Shekar Patil
5  HCG Group of Hospital, Bangalore, Karnataka, India
,
Prabhat Bhargava
1  Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
,
Vikas Ostwal
1  Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
› Author Affiliations
Funding No funding received for study.

Abstract

Background Ramucirumab is considered a standard of care as second-line therapy (CT2) in advanced gastric cancers (AGCs). The aim of this study was to assess practice patterns and outcomes with ramucirumab among Indian patients with AGCs.

Materials and Methods A computerized clinical data entry form was formulated by the coordinating center’s (Tata Memorial Hospital) medical oncologists and disseminated through personal contacts at academic conferences as well as via email for anonymized patient data entry. The data was analyzed for clinical characteristics, response rates, and survival outcomes.

Results A total of 26 physicians contributed data, resulting in 55 patients receiving ramucirumab and being available for analysis. Median age was 53 years (range: 26–78), 69.1% of patients had greater than two sites of disease, and baseline Eastern Cooperative Oncology Group’s performance score (ECOG PS) ≥ 2 was seen in 61.8% of patients. Ramucirumab was used as monotherapy in 10.9% of patients, while the remaining 89.1% received ramucirumab combined with chemotherapy. Median event-free survival (EFS) and median overall survival (OS) with ramucirumab were3.53 months (95% CI: 2.5–4.57) and 5.7 months (95% CI: 2.39–9.0), respectively. Common class specific grade adverse events seen with ramucirumab included gastrointestinal (GI) hemorrhage (9.1% - all grades) and uncontrolled hypertension (Grade 3/4 - 3.6%).

Conclusions Ramucirumab appears to have similar efficacy in Indian AGC patients when compared with real-world data from other countries in terms of median EFS, but OS appears inferior due to more patients having borderline ECOG PS and high metastatic disease burden. GI hemorrhages appear more common than published data, although not unequivocally related to ramucirumab.



Publication History

Publication Date:
04 September 2021 (online)

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