# RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in previously treated advanced gastric cancer

Source: https://onco.cc/key-papers/paper-rainbow-ramucirumab-paclitaxel-lancet-oncol-2014/  
OnCo record `paper-rainbow-ramucirumab-paclitaxel-lancet-oncol-2014` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding the anti-VEGFR2 antibody ramucirumab to weekly paclitaxel lengthened survival by over two months in gastric cancer that had progressed after first-line chemotherapy, establishing the standard second-line regimen.

## Summary

Phase 3 placebo-controlled trial of 665 patients with advanced gastric or junctional adenocarcinoma progressing after first-line platinum-fluoropyrimidine chemotherapy randomised to ramucirumab or placebo with weekly paclitaxel.

Median overall survival was 9.6 versus 7.4 months (hazard ratio 0.81), progression-free survival 4.4 versus 2.9 months and response 28 versus 16 percent; neutropenia, hypertension and fatigue were more frequent with ramucirumab.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2014
- DOI: 10.1016/S1470-2045(14)70420-6
- Authors: Wilke H, Muro K, Van Cutsem E, et al.
- Findings: Median overall survival 9.6 vs 7.4 months; hazard ratio 0.81.; Median progression-free survival 4.4 vs 2.9 months.
- What it means: Ramucirumab-paclitaxel is the second-line standard for HER2-negative gastric cancer after chemo-immunotherapy, and the comparator for newer agents.
- Caveats: Regional differences: benefit was smaller in Asian patients, partly because of more third-line therapy.

## Sources

- Lancet Oncol 2014: https://doi.org/10.1016/S1470-2045(14)70420-6
- PubMed: https://pubmed.ncbi.nlm.nih.gov/25240821/

## Connected records

- cancers: [Claudin 18.2-positive gastric cancer](https://onco.cc/cancers/gastric-cldn18-2-positive/), [PD-L1-high gastric cancer](https://onco.cc/cancers/gastric-pdl1-high/)
- drugs: [Ramucirumab](https://onco.cc/drugs/ramucirumab/)
- trials: [RAINBOW](https://onco.cc/trials/rainbow/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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