Dr. El-Khoueiry on the Role of Ramucirumab in Advanced HCC

Anthony B. El-Khoueiry, MD, associate professor of clinical medicine, Keck School of Medicine, USC Norris Comprehensive Cancer Center, discusses the role of ramucirumab (Cyramza) in advanced hepatocellular carcinoma (HCC).

Ramucirumab, a VEGFR-2 antibody, is one of several agents that has been tested in the second-line setting for patients who have previously been treated with sorafenib (Nexavar). The drug was first evaluated in the phase III REACH study, which was negative. However, a subgroup analysis indicated that patients with an alpha-fetoprotein (AFP) ≥400 benefitted from ramucirumab. Therefore, the phase III REACH-2 study was launched, homing in on this specific patient population.

REACH-2 was a positive study showing an improvement in overall survival (OS) with ramucirumab versus placebo in patients with AFP ≥400. The median OS of 8 months was a little bit less than what has been seen with the VEGF TKIs in this space, but cross-trial comparisons have caveats, El-Khoueiry says. In a joint analysis of REACH and REACH-2, it was determined that there was a 3-month improvement in OS with ramucirumab in this select population.