The US Food and Drug Administration (FDA) has approved Eli Lilly's Cyramza (ramucirumab) as a single-agent treatment for patients with advanced or metastatic gastric cancer or gastroesophageal junction (GEJ) adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy. With this approval, Cyramza becomes the first FDA-approved treatment for patients in this setting.

"Lilly Oncology is committed to delivering innovative medicines that extend the lives of people with cancer," said Richard Gaynor, managing director,  senior vice president, product development and medical affairs for Lilly Oncology. "Until now, there were no FDA-approved options for patients in this indication. We are pleased that the FDA has approved Cyramza for these patients. This is an aggressive disease that is difficult to treat, and the prognosis has typically been very poor."

The Cyramza (ramucirumab injection 10 mg/mL solution) approval is based on results of REGARD, a multicentre, randomised, placebo-controlled, double-blind trial of patients with locally advanced or metastatic gastric cancer including GEJ adenocarcinoma previously treated with fluoropyrimidine- or platinum-containing chemotherapy.

It is the first phase III trial to show improved overall survival and progression-free survival with a biologic agent in advanced gastric cancer after prior chemotherapy. Results demonstrated that Cyramza (8 mg/kg by infusion every two weeks) plus best supportive care (BSC), as compared to placebo plus BSC, increased the median overall survival of patients with advanced gastric cancer by 37 per cent (median overall survival of 5.2 months [95 per cent confidence interval vs. 3.8 months [95 per cent  for placebo, P=0.047, hazard ratio 0.78 [95 per cent CI 0.60, 0.998]). Additionally, Cyramza significantly improved progression-free survival, demonstrating a 62 per cent increase in median progression-free survival (2.1 months [95 per cent vs. 1.3 months [95 per cent for placebo, P < 0.001, hazard ratio 0.48 [95 per cent].

The labelling for Cyramza contains a Boxed Warning regarding increased risk of hemorrhage, including severe and sometimes fatal events. Cyramza should be discontinued in patients who experience severe bleeding. The most commonly reported adverse reactions (all grades) in REGARD, occurring in at least 5 per cent of patients receiving Cyramza and at a rate at least 2 per cent higher than those receiving placebo, were hypertension (16 per cent vs. 8 per cent), diarrhoea (14 per cent vs. 9 per cent), headache (9 per cent vs. 3 per cent ), and hyponatremia (6per cent vs. 2 per cent ). The most common serious adverse events with Cyramza were anaemia (3.8 per cent) and intestinal obstruction (2.1per cent).

Red blood cell transfusions were given to 11 per cent of Cyramza-treated patients vs. 8.7 per cent of patients who received placebo. Across clinical trials of Cyramza administered as a single agent, clinically relevant adverse reactions (including Grade greater than or equal to 3) reported in Cyramza-treated patients included proteinuria, gastrointestinal perforation, and infusion-related reactions. In REGARD, according to laboratory assessment, eight per cent of Cyramza-treated patients developed proteinuria versus three per cent of placebo-treated patients. Two patients discontinued Cyramza due to proteinuria. The rate of gastrointestinal perforation in the REGARD trial was 0.8 per cent and the rate of infusion-related reactions was 0.4 per cent . This is not a complete list of adverse reactions. For full safety information, see the Important Safety Information at the end of this press release and the full Prescribing Information.

"There is a high unmet medical need in patients with this disease," said Charles Fuchs, managing director, M.P.H., principal investigator of the REGARD trial and director, Gastrointestinal Malignancy programme , Dana-Farber Cancer Institute. "This approval represents a meaningful advance for patients and gives those of us who treat them an important new second-line treatment option."

"As someone who has experienced firsthand the limited options available to treat this devastating disease, I consider this approval to be much needed. This is a significant moment for many patients and their families," said Debbie Zelman, president and founder of a leading international patient advocacy organization, Debbie's Dream Foundation, which is dedicated to raising awareness about gastric cancer, advancing funding for research, and providing education and support to those affected by the disease. Zelman founded the organization following her own gastric cancer diagnosis. Lilly Oncology and Debbie's Dream Foundation have established a partnership to improve patient and caregiver awareness of and access to gastric cancer resources.

Cyramza is a vascular endothelial growth factor (VEGF) Receptor 2 antagonist that specifically binds VEGF Receptor 2 and blocks binding of VEGF receptor ligands VEGF-A, VEGF-C, and VEGF-D. VEGF Receptor 2 is an important mediator in the VEGF pathway.

In an in vivo animal model, ramucirumab inhibited angiogenesis. Angiogenesis is a process by which new blood vessels form to supply blood to normal healthy tissues as well as tumours, enabling the cancer to grow.   

FDA approval of Cyramza marks a pivotal regulatory milestone in Lilly's research and development programme  for the molecule, which it acquired when it purchased ImClone Systems in 2008. Cyramza has been granted Orphan Drug Designation by the FDA for this indication. Orphan drug status is given in the US by the FDA's Office of Orphan Products Development (OOPD) to medicines that show promise for the treatment of rare diseases. Lilly expects to make Cyramza available in the coming weeks and is committed to offering patient assistance programmes for eligible patients receiving Cyramza treatment.  

Patients, physicians, pharmacists or other healthcare professionals with additional questions about Cyramza should contact The Lilly Answer Center at 1-800-LillyRx.

Angiogenesis is the process of making new blood vessels. This process involves the migration, growth, and differentiation of endothelial cells, which line the inside wall of blood vessels. Chemical signals in the body stimulate the repair of damaged blood vessels and formation of new blood vessels during this process.

In a person with cancer, angiogenesis creates new blood vessels that give a tumour its own blood supply, allowing it to grow and spread.

Some tumours create proteins called VEGF. These proteins attach to the VEGF receptors of blood vessel cells causing new blood vessels to form around the tumours, enabling growth. Blocking the VEGF protein from linking to the blood vessels helps to inhibit tumour growth by slowing angiogenesis and the blood supply that feeds tumours.

Of the three known VEGF receptors, VEGF Receptor 2 is linked most closely to VEGF-induced tumour angiogenesis.Progressed after prior fluoropyrimidine- or platinum-containing chemotherapy. Cyramza inhibited angiogenesis in an in vivo animal model. Cyramza is a VEGF Receptor 2 antagonist that specifically binds and blocks activation of VEGF Receptor 2 and blocks binding of VEGF receptor ligands VEGF-A, VEGF-C, and VEGF-D.