Dr. Ilson on Investigative TKI Combinations in Gastric Cancer

David H. Ilson, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses TKI combinations under investigation in gastric cancer.

The addition of ramucirumab (Cyramza), an anti-VEGF therapy, to second-line chemotherapy with paclitaxel improves outcomes, explains Ilson. A recent publication showed no benefit when ramucirumab was added to chemotherapy in the frontline setting. Other TKIs that target the VEGF pathway, such as regorafenib (Stivarga) and apatinib, are being investigated.

Apatinib was approved in China based on a survival benefit versus best supportive care, says Ilson. The phase III trial conducted in the West, on the other hand, was a negative trial, meaning apatinib will likely not move forward in development, according to Ilson.

Regorafenib remains the subject of ongoing randomized trials compared with best supportive care in patients with refractory gastric cancer. Some preliminary data for the combination of TKIs and checkpoint inhibitors indicate there may be a role for these combinations, concludes Ilson.