# REACH-2

Source: https://onco.cc/trials/reach-2/  
OnCo record `reach-2` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

REACH-2 showed that the antibody ramucirumab helped people with liver cancer live longer after sorafenib, but only when a blood marker, alpha-fetoprotein, was high, making it the first liver cancer drug approved on a biomarker.

## Summary

The earlier REACH trial of ramucirumab, an antibody against VEGF receptor 2, missed its overall survival endpoint in the whole population but showed a benefit in patients with an alpha-fetoprotein of 400 ng/mL or more. REACH-2 tested exactly that group: patients with advanced hepatocellular carcinoma who had progressed on or were intolerant of sorafenib were randomised two to one to ramucirumab or placebo, with overall survival as the primary endpoint.

Ramucirumab lengthened overall survival and progression-free survival compared with placebo, confirming the biomarker hypothesis, and was approved in the United States in May 2019 for this population, the first biomarker-selected approval in hepatocellular carcinoma.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-17
- Tags: subtype-trials
- Registry id: NCT02435433
- Phase: 3
- Setting: Advanced hepatocellular carcinoma after sorafenib with a baseline alpha-fetoprotein of 400 ng/mL or more: ramucirumab against placebo
- Sponsor: Eli Lilly
- Result: Ramucirumab improved overall survival over placebo in alpha-fetoprotein-high hepatocellular carcinoma after sorafenib; approved in May 2019.
- Outcomes: Overall survival: Ramucirumab 8 mg/kg 8.5 months vs Placebo 7.3 months, HR 0.71; Progression-free survival: Ramucirumab 8 mg/kg 2.8 months vs Placebo 1.6 months, HR 0.452; Objective response: Ramucirumab 8 mg/kg 5% vs Placebo 1%; Grade 3 or worse hypertension: Ramucirumab 8 mg/kg 13% vs Placebo 5%

## Sources

- ClinicalTrials.gov NCT02435433: https://clinicaltrials.gov/study/NCT02435433

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- drugs: [Ramucirumab](https://onco.cc/drugs/ramucirumab/)
- companies: [Eli Lilly (incl. Loxo)](https://onco.cc/companies/eli-lilly/)
- people: [Andrew X. Zhu](https://onco.cc/people/andrew-zhu/)

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