Metastatic gastric cancer treatment: Second line and beyond

Table 1 Positive phase III trials of cytotoxic agents in second line metastatic cancers

Ref.	Patients/phase	Treatment	Indication	Results (PFS/OS/RR) (mo)
Ford et al[18], 2014	168/III	Docetaxel	Advanced, gastric cancer that had progressed on or within 6 mo of treatment with a platinum-fluoropyrimidine combination	OS: 5.2
COUGAR-02		Active symptom control		OS: 3.6
Kang et al[28], 2012[28]	202/III	Docetaxel	Advanced gastric cancer with one or two prior chemotherapy regimens involving both fluoropyrimidines and platinum	5.2
		Irinotecan		6.5
		BSC		3.8

Table 2 Approved targeted therapies in second line metastatic gastric cancer

Ref.	Patients/phase	Treatment	Indication	Results (PFS/OS/RR) (mo)
Iwasa et al[49], 2013	46/II	Paclitaxel + Trastuzumab	HER2-positive, metastatic gastric cancer patients naive to trastuzumab, who received one or more lines of chemotherapy	ORR: 37.2% PFS: 5.2
Wilke et al[53], 2014 RAINBOW	665/III	Paclitaxel + Ramicirumab Paclitaxel + Placebo	Advanced gastric cancer and disease progression on or within 4 mo after first-line chemotherapy (platinum plus fluoropyrimidine with or without an anthracycline)	OS: 9.6 OS: 7.4
Fuchs et al[52], 2015 REGARD	355/III	Ramicirumab Placebo	Advanced gastric or gastro-oesophageal junction adenocarcinoma and disease progression after first-line platinum-containing or fluoropyrimidine-containing chemotherapy	OS: 5.2 OS: 3.8