This is a patient* with advanced or metastatic gastric or GEJ adenocarcinoma – someone who knows their situation, but is not surrendering to it.
- Presents with difficulty swallowing
- No prior surgery
- Unresectable stage IV gastric or GEJ adenocarcinoma
- FOLFOX 1L; oxaliplatin dropped after 4 cycles due to low-grade neuropathy
- Disease progressed after 6 months
- Current scan shows metastases in distant lymph nodes and liver
- ECOG PS 1
Can you picture one of your patients? Someone who is determined and counting on you for answers?
CYRAMZA as a single agent, or in combination with paclitaxel, is indicated for the treatment of patients with advanced or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy.
CYRAMZA + paclitaxel: The most frequently prescribed regimen in 2L†
CYRAMZA + Paclitaxel Is Proven to Extend Survival, Delay Progression, and Improve Response Rate2 (versus placebo + paclitaxel)
SELECT IMPORTANT SAFETY INFORMATION
The labeling for CYRAMZA contains warnings and precautions for hemorrhage and GI hemorrhage, including severe and sometimes fatal events; gastrointestinal (GI) perforations, a potentially fatal event; impaired wound healing; arterial thromboembolic events (ATEs), including serious and sometimes fatal events; hypertension; infusionrelated reactions (IRR), including severe and sometimes fatal events; worsening of pre-existing hepatic impairment; posterior reversible encephalopathy syndrome (PRES), including fatal events; proteinuria including nephrotic syndrome; thyroid dysfunction; and embryo-fetal toxicity. CYRAMZA should be permanently discontinued in patients who experience severe bleeding, a GI perforation, an ATE, uncontrolled hypertension, severe IRR, PRES, or urine protein >3 grams/24 h or nephrotic syndrome.
In RAINBOW, the most common adverse reactions (all Grades) observed in patients treated with CYRAMZA with paclitaxel at a rate of ≥30% and ≥2% higher than placebo with paclitaxel were fatigue/asthenia (57% vs 44%), neutropenia (54% vs 31%), diarrhea (32% vs 23%), and epistaxis (31% vs 7%). The most common serious adverse reactions with CYRAMZA with paclitaxel were neutropenia (3.7%) and febrile neutropenia (2.4%); 19% of patients treated with CYRAMZA with paclitaxel received granulocyte colony-stimulating factors.
RAINBOW Trial Design (N=665)2,6
The phase III RAINBOW trial evaluated the efficacy and safety of CYRAMZA plus paclitaxel vs placebo plus paclitaxel in patients with locally advanced or metastatic gastric or GE junction adenocarcinoma with disease progression on or after prior fluoropyrimidine- and platinum-containing chemotherapy. Major efficacy outcome measure was overall survival. Supportive efficacy outcome measures were progression-free survival and overall response rate. All patients were Eastern Cooperative Oncology Group performance status 0 or 1. Prior to enrollment, 97% of patients had progressed during treatment or within 4 months after the last dose of first-line chemotherapy for metastatic disease. Twenty-five percent of patients had received anthracycline in combination with platinum/fluoropyrimidine therapy, while 75% did not. Patients were randomized 1:1 to CYRAMZA 8 mg/kg (n=330) or placebo (n=335) every 2 weeks (on days 1 and 15) of each 28-day cycle. Patients in both arms received paclitaxel 80 mg/m2 on days 1, 8, and 15 of each 28-day cycle.
Ramucirumab + paclitaxel: The only FDA-approved combination regimen for the treatment of advanced or metastatic gastric or GEJ adenocarcinoma in the second-line setting and a Category 1 recommendation within the NCCN Guidelines®2-4
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommendations for ramucirumab (CYRAMZA)
CATEGORY 1: Based upon high-level evidence, there is uniform National Comprehensive Cancer Network® (NCCN®) consensus that the intervention is appropriate3,4
SELECT IMPORTANT SAFETY INFORMATION
- CYRAMZA increased the risk of hemorrhage and gastrointestinal hemorrhage, including Grade ≥3 hemorrhagic events. In 2137 patients with various cancers treated with CYRAMZA, the incidence of all Grade hemorrhage ranged from 13- 55%. Grade 3-5 hemorrhage incidence ranged from 2-5%.
- Patients with gastric cancer receiving nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded from enrollment in REGARD and RAINBOW; therefore, the risk of gastric hemorrhage in CYRAMZA-treated patients with gastric tumors receiving NSAIDs is unknown.
- Permanently discontinue CYRAMZA in patients who experience severe (Grade 3 or 4) bleeding.
Second-line treatment trendsLearn about how the second-line treatment landscape has evolved