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Ramucirumab: a promising development in advanced non-small cell lung cancer

Virginie Avrillon & Maurice Perol

The VEGF pathway is a critical target for anti-angiogenic therapy in advanced nonsmall cell lung cancer (NSCLC). Bevacizumab, a monoclonal antibody targeting VEGF-A, is the only anti-angiogenic agent approved for first-line use in combination with platinum-based chemotherapy. Ramucirumab is another monoclonal antibody that specifically binds to the extracellular domain of the main angiogenic receptor VEGFR-2 on endothelial cells. Clinical development of ramucirumab demonstrated promising activity and a tolerable safety profile in combination with first-line chemotherapy in advanced NSCLC. Recently, the REVEL Phase III trial, including both squamous and nonsquamous carcinoma, demonstrated that the addition of ramucirumab to standard second-line docetaxel provided a significant improvement of overall survival, providing an evidence for VEGFR-targeted antiangiogenic therapy in advanced NSCLC.