Abstract
Background/aim
Ramucirumab (RAM) plus taxane is the standard second-line treatment for unresectable advanced gastric cancer (AGC). However, the clinical outcomes of this regimen after immune checkpoint inhibitor (ICI)-based first-line therapy remain unclear, particularly in patients who exhibit progressive disease (PD) as the best overall response to prior treatment.Patients and methods
We analyzed the data of 31 patients with HER2-negative AGC who received RAM plus taxane as a second-line therapy after ICI-based treatment in our institution between November 2021 and March 2025. Survival and response rates were compared between the PD and non-PD groups in the first-line treatment setting.Results
The median progression-free survival (PFS) and overall survival (OS) were 3.26 months and 5.83 months, respectively. The Eastern Cooperative Oncology Group performance status ≥2 was the only independent poor prognostic factor for both PFS and OS. Among the 23 patients with measurable disease, the objective response rate (ORR) was 30.4%. When stratified according to response to first-line therapy, no significant differences in PFS or OS were observed between patients with PD (n=11) and without PD (n=20). However, the ORR was significantly higher in the PD group than in the non-PD group (54.5% vs. 8.3%, p=0.027).Conclusion
Although poor performance status was associated with worse survival, RAM plus taxane demonstrated meaningful antitumor activity, regardless of response to prior ICI-based treatment. These findings suggest that RAM plus taxane may warrant consideration as a treatment option in this setting.