Comparison of the Clinical Outcome of Ramucirumab for Unresectable Hepatocellular Carcinoma with That of Prior Tyrosine Kinase Inhibitor Therapy

Abstract

Introduction: The clinical outcome of ramucirumab in multi-molecular targeted agent (MTA) sequential therapy for unresectable hepatocellular carcinoma (u-HCC) was assessed in comparison with that of prior tyrosine kinase inhibitor (TKI) therapy. Methods: Sixteen patients who received ramucirumab as part of multi-MTA sequential therapy for u-HCC were enrolled in a retrospective, cohort study. Ramucirumab was started as 2nd line in 7 patients, 3rd line in 5 patients, and 4th line in 4 patients. Results: The overall response rate was 6.3%, the disease control rate (DCR) was 50.0%, median progression-free survival was 2.0 months (evaluated by mRECIST), median overall survival (OS) with ramucirumab was 7.9 months, and the median OS from 1st-line therapy was 28.1 months. One month after the start of ramucirumab, α-fetoprotein (AFP) decreased in 6 of 12 cases (50.0%), and the DCR in AFP-decreased cases was 83.3%. The DCR of ramucirumab was 66.7% in cases in which disease control was obtained by prior TKI therapy, whereas it was 0.0% in the cases in which disease control was not obtained by prior TKI therapy. Examining the adverse events, no new safety concerns were confirmed. Conclusion: The AFP response to ramucirumab and the treatment response to prior TKI therapy are associated with treatment response to ramucirumab.

A preliminary study on drug switching strategy for second-line therapy after combination treatment of tyrosine kinase inhibitors and immune checkpoint inhibitors for unresectable hepatocellular carcinoma

“…Surprisingly, the median SPFS of group A was longer than that of group B (5.47 vs. 3.8 months, p = 0.0176). These data suggest that the median SPFS in our study was significantly extended compared to that of a previous study where the sequence ramucirumab for uHCC after TKI treatment (Amioka et al, 2021). However, we observed no differences in the OS between groups A and B.…”

Impact of post‐progression survival in second‐line treatment with molecular target agents for unresectable hepatocellular carcinoma

“…A search of the PubMed database identified 24 cohorts in 23 studies encompassing 2074 patients treated with REG (Figure 1 and Table ) 11,14–35 . Similarly, six cohorts from six studies comprising 621 patients treated with RAM 12,36–40 were identified, as well as seven cohorts from six studies involving 1240 patients treated with CAB 13,23,33,41–43 (Figure 1 and Tables and , respectively). In the present study, patients with Child‐Pugh B were identified with 183/1622 (11.3%), 53/621 (8.5%), and 37/909 (9.2%) in REG, RAM, and CAB cohort, respectively (Tables ).…”

Factors predictive of clinical outcome in advanced hepatocellular carcinoma patients receiving ramucirumab treatment: A real‐world experience

“…Although a barely satisfactory objective response rate was expected when used as a single agent for second-line treatment, ramucirumab showed good disease control rate and on-treatment AFP response in the REACH and REACH-2 cohorts. 4,31 In real-world experience, 29,32,33 ramucirumab has been used after systemic treatment other than sorafenib and has been used for more than second-line treatment. Kuzuya et al found that AFP level decreased at 2 weeks in 50% of patients and the disease control rate was 80%, in those receiving ramucirumab after lenvatinib.…”