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Second-Line Mesothelioma Treatment with Ramucirumab

ByAlex Strauss
second-line mesothelioma treatment

A combination of ramucirumab (CYRAMZA) and gemcitabine creates a promising second-line mesothelioma treatment.

New research shows the combination nearly doubled survival in a group of patients whose tumors kept growing with standard therapy. 

Italian researchers shared their findings at the virtual annual meeting of ASCO. ASCO is one of the largest gatherings of cancer doctors in the US.

First-Line Mesothelioma Treatment Failure

For most mesothelioma patients, chemotherapy with Alimta is the first-line treatment. This does keep the cancer in check for some patients. But after a while, mesothelioma tumors almost always come back. Chemotherapy only extends survival by about four months. 

Doctors have tested many different approaches to second-line mesothelioma treatment.  Some of the therapies tested are:

Unfortunately, none of the tested drugs have improved mesothelioma survival by more than eight months. This makes the results of the latest second-line mesothelioma treatment trial especially encouraging.

New Combination for Second-Line Mesothelioma Treatment

The proposed new second-line mesothelioma treatment combines two drugs. The first is gemcitabine. Gemcitabine has been the focus of several drug combination trials for mesothelioma.

Researchers at AUSL-IRCCS Reggio Emilia led the RAMES Study. It combines gemcitabine with ramucirumab (CYRAMZA) for patients who failed standard treatment.

One hundred and sixty-four patients joined the second-line mesothelioma treatment trial. Most trial participants were men with a median age of 69. Most had the epithelioid mesothelioma subtype. 

The trial ran from 2016 to 2018. Eighty-one patients received gemcitabine and a placebo. Eighty patients received gemcitabine and ramucirumab. 

Promising Treatment Results

In the RAMES trial, patients who got gemcitabine and ramucirumab had a median overall survival of 13.8 months. This was significantly longer than the 7.5 months in those who took the placebo combination. 

There were no major differences in the number of blood clots or blood-related toxicities between the two groups. The combo group did have a slightly higher incidence of high blood pressure. This second-line mesothelioma treatment appeared to work independent of other risk factors. 

“The addition of ramucirumab to gemcitabine significantly improved overall survival regardless of age of patients, tumor histotype and time to progression at the first-line treatment,” writes lead investigator Maria Pagano. 

Dr. Pagano and her colleagues conclude that the combination “can be considered a manageable regimen in second-line treatment of advanced malignant pleural mesothelioma patients.”

Next, the team will determine if the treatment improves quality of life for mesothelioma patients. They will also try to determine if people with certain mutated genes respond better than others. 

Sources:

Pagana, et al, “Randomized phase II study on gemcitabine with or without ramucirumab as second-line treatment for advanced malignant pleural mesothelioma (MPM): Results of Italian Rames Study”, May 2020, ASCO Meeting Library, https://meetinglibrary.asco.org/record/184551/abstract

“Ramucirumab–gemcitabine encouraging in second-line malignant pleural mesothelioma”, June 18, 2020, ASCO 2020 news release, https://www.medwirenews.com/oncology/respiratory/ramucirumab-gemcitabine-malignant-pleural-mesothelioma/18096212

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