Early switch maintenance in gastric cancer: who benefits most?
Mené en Italie sur 280 patients atteints d'un cancer de l'estomac ou de la jonction oesogastrique HER2- de stade localement avancé ou métastatique (durée médiane de suivi : 43,7 mois), cet essai multicentrique de phase III évalue l'efficacité, du point de vue de la survie sans progression, et la toxicité d'un traitement d'entretien ou de deuxième ligne précoce par ramucirumab et paclitaxel après une chimiothérapie de première ligne par oxaliplatine
Résumé en anglais
The ARMANI trial, a phase 3 multicentre study reported by Giovanni Randon and colleagues,1 investigates the effect of switch maintenance with paclitaxel plus ramucirumab versus continued oxaliplatin-based chemotherapy in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer. First-line treatments have historically relied on fluoropyrimidine and platinum agents, but more recent approaches incorporate biomarker-guided targeted therapies, including those based on PD-L1 combined positive score, mismatch repair status or microsatellite instability, and claudin-18.2 expression. Despite these innovations, the prognosis for patients with HER2-negative gastric or gastro-oesophageal junction cancer remains poor due to rapid disease progression, a decline in performance status, and difficulty in identifying disease progression on diagnostic imaging, which complicates timely therapeutic transitions.
