{"entity":{"id":"reach-2","kind":"trial","name":"REACH-2","aka":[],"tldr":"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.\n\nRamucirumab 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.","status":"positive","asOf":"2026-09-17","links":[{"label":"ClinicalTrials.gov NCT02435433","url":"https://clinicaltrials.gov/study/NCT02435433"}],"tags":["subtype-trials"],"related":[],"cancers":["hcc-advanced","hcc"],"sections":[],"technologies":[],"targets":[],"drugs":["ramucirumab"],"companies":["eli-lilly"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["andrew-zhu"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"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.","yearReported":2019,"outcomes":[{"endpoint":"Overall survival","primary":true,"unit":"months","arms":[{"name":"Ramucirumab 8 mg/kg","n":197,"value":8.5,"note":"Median follow-up 7.6 months"},{"name":"Placebo","n":95,"value":7.3}],"hr":0.71,"ci":[0.531,0.949],"p":"0.0199","source":"https://doi.org/10.1016/s1470-2045(18)30937-9"},{"endpoint":"Progression-free survival","unit":"months","arms":[{"name":"Ramucirumab 8 mg/kg","n":197,"value":2.8},{"name":"Placebo","n":95,"value":1.6}],"hr":0.452,"ci":[0.339,0.603],"p":"<0.0001","source":"https://doi.org/10.1016/s1470-2045(18)30937-9"},{"endpoint":"Objective response","unit":"%","arms":[{"name":"Ramucirumab 8 mg/kg","n":197,"value":5},{"name":"Placebo","n":95,"value":1}],"p":"0.1697","source":"https://doi.org/10.1016/s1470-2045(18)30937-9"},{"endpoint":"Grade 3 or worse hypertension","unit":"%","arms":[{"name":"Ramucirumab 8 mg/kg","n":197,"value":13},{"name":"Placebo","n":95,"value":5}],"source":"https://doi.org/10.1016/s1470-2045(18)30937-9"}]},"route":"/trials/reach-2/","neighbours":{"cancer":[{"id":"hcc-advanced","kind":"cancer","name":"Advanced hepatocellular carcinoma (BCLC C)","route":"/cancers/hcc-advanced/"},{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"}],"drug":[{"id":"ramucirumab","kind":"drug","name":"Ramucirumab","route":"/drugs/ramucirumab/"}],"company":[{"id":"eli-lilly","kind":"company","name":"Eli Lilly (incl. Loxo)","route":"/companies/eli-lilly/"}],"person":[{"id":"andrew-zhu","kind":"person","name":"Andrew X. Zhu","route":"/people/andrew-zhu/"}]}}