Clinical Outcomes of Ramucirumab Plus Taxane After Immune Checkpoint Inhibitor Therapy in HER2-negative Advanced Gastric Cancer

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.