Meta-analysis of individual patient safety data from six randomized, placebo-controlled trials with the antiangiogenic VEGFR2-binding monoclonal antibody ramucirumab

Abstract

Background:Ramucirumab, the human IgG1 monoclonal antibody receptor antagonist of vascular endothelial growth factor receptor 2 (VEGFR-2), has been approved for treating gastric/gastroesophageal junction, non-small cell lung, and metastatic colorectal cancers. With the completion of 6 global, randomized, double-blind, placebo-controlled, phase 3 trials across multiple tumor types, an opportunity now exists to further establish the safety parameters of ramucirumab across a large patient population.Materials and methods:An individual patient meta-analysis across the 6 completed phase 3 trials was conducted and the relative risk (RR) and associated 95% confidence intervals (CI) were derived using fixed-effects or mixed-effects models for all-grade and high-grade adverse events (AEs) possibly related to VEGF pathway inhibition. The number needed to harm (NNH) was also calculable, due to the placebo-controlled nature of all 6 registration standard trials.Results:A total of 4996 treated patients (N = 2748 in the ramucirumab arm, and N = 2248 in the control, placebo arm) were included in this meta-analysis. Arterial thromboembolic events (ATE, all-grade, RR: 0.8, 95% CI 0.5-1.3; high-grade [Grade ≥3], RR: 0.9, 95% CI 0.5-1.7), venous thromboembolic events (VTE, all-grade, RR: 0.7, 95% CI 0.5-1.1; high-grade, RR: 0.7, 95% CI 0.4-1.2), high-grade bleeding (RR: 1.1, 95% CI 0.8-1.5), and high-grade gastrointestinal (GI) bleeding (RR: 1.1, 95% CI 0.7-1.7) did not demonstrate a definite increased risk with ramucirumab. A higher percentage of hypertension, proteinuria, low-grade (Grade 1-2) bleeding, GI perforation, infusion-related reaction and wound-healing complications were observed in the ramucirumab arms compared to control.Conclusions:Ramucirumab may be distinct among antiangiogenic agents in terms of ATE, VTE, high-grade bleeding, or high-grade GI bleeding by showing no clear evidence for an increased risk of these AEs in this meta-analysis of a large and diverse patient population. Ramucirumab is consistent with other angiogenic inhibitors in the risk of developing certain AEs.Clinical Trial Numbers: The registered clinical trials utilized in this meta-analysis nclude: NCT00917384 (REGARD), NCT01170663 (RAINBOW), NCT01168973 (REVEL), NCT01183780 (RAISE), NCT01140347 (REACH), and NCT00703326 (ROSE)

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