An early switch in first-line therapy improves outcomes of advanced-stage G/GEJC

Many patients with advanced-stage gastric or gastro-oesophageal junction cancer (G/GEJC), particularly those deemed ineligible for combination therapy incorporating antibodies targeting HER2, PD-1 or claudin-18.2, receive chemotherapy alone in the first line. Disease progression typically occurs within a few months and the associated morbidities often preclude standard second-line treatment with ramucirumab plus paclitaxel. Now, results from the phase III ARMANI trial indicate that an early switch from induction chemotherapy to maintenance ramucirumab–paclitaxel improves outcomes.

In ARMANI, 280 patients with unresectable HER2-negative G/GEJC and disease control after 3 months of induction folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) or capecitabine and oxaliplatin (CAPOX) were randomly assigned 1:1 to receive continuous ramucirumab–paclitaxel (switch maintenance group) or a further 3 months of FOLFOX or CAPOX followed by single-agent fluoropyrimidine maintenance (control group). The primary end point was progression-free survival (PFS).