Ramucirumab is the only Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) monoclonal antibody drug currently available worldwide. This drug inhibits the formation of tumor neovascularization by blocking VEGFR2 and the signaling pathway of angiogenesis to achieve anti-tumor effects.
Remolimumab plays an active role in the treatment of gastric cancer, non-small cell lung cancer, and colorectal cancer.
So how does ramolutumab perform in the treatment of liver cancer? Let’s take a look together.
Antitumor mechanism of ramolutumab
Tumor growth is not only related to its own growth activity, but also to the environment in which it lives, which we call the “microenvironment” of the tumor. In general, malignant tumors are surrounded by a large number of abnormal blood vessels, creating an imbalanced microenvironment that inhibits the survival of normal tissues and accelerates the progression of tumor disease.
Remolimumab is an antibody that exerts an anti-tumor effect by blocking VEGFR2 and the signaling pathway of angiogenesis, inhibiting tumor neovascularization, degrading existing blood vessels, and rebalancing the tumor microenvironment in a short period of time. In actual treatment, ramolutumab mostly works in combination with other drugs.
Patients with high methemoglobin have the most benefit with ramolutumab
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Treatment options for advanced hepatocellular carcinoma are relatively limited, and the prognosis is poor. Can ramolutumab make the same splash as it has in lung and gastric cancer and advanced colorectal cancer?
This brings us to the REACH trial, which was designed to compare “ramolutumab + best supportive care” with “placebo + best supportive care” as a second-line treatment for hepatic cancer after sorafenib, the current standard of care for targeted therapy in advanced hepatocellular carcinoma. The efficacy of this treatment in patients with hepatocellular carcinoma after first-line treatment with sorafenib, the current standard of care for advanced hepatocellular carcinoma.
The results of the study showed a median overall survival of 9.2 months in the treatment group with ramolutumab and 7.6 months in the placebo-treated group. Although there was no difference after statistical analysis of the results, it was encouraging that survival was significantly better with ramolutumab in patients with elevated baseline alpha fetoprotein (AFP) values of no less than 400 ng/mL.
In this group, the median overall survival after ramolutumab treatment was 7.8 months compared with just 4.2 months in the placebo group, suggesting that ramolutumab may have the greatest benefit in patients with hepatocellular carcinoma with elevated alpha fetrotein.
During treatment, the main adverse effects of ramolutumab were malaise and hypertension, which were often well tolerated by patients.
Summary
It is worth noting that ramolutumab for hepatocellular carcinoma treatment has now been granted orphan drug status in the US and EU (orphan drug status, usually granted to drugs that have shown good promise for rare diseases).
We believe that ramolutumab has broad promise in the treatment of hepatocellular carcinoma and in particular may offer new options for the treatment of advanced hepatocellular carcinoma.
Although ramolutumab has not yet been approved in China for the treatment of hepatocellular carcinoma, a clinical trial in China is already in full swing. The trial is designed to evaluate the efficacy of ramolutumab versus placebo in patients with advanced hepatocellular carcinoma who have previously received sorafenib and are intolerant or whose disease has progressed.
We look forward to the day when ramolutumab will be a boon to our patients with hepatocellular carcinoma.