OBJECTIVE:Synovial sarcoma usually presents with spindle cell morphology with or without epithelial differentiation. Extensive rhabdoid differentiation is a very rare feature with only few cases described in literature. CASE REPORT:We present two cases of synovial sarcoma with rhabdoid differentiation along with their clinical follow-up. Both cases had tumor in the vicinity of joints and showed lung metastasis during follow-up inspite of R0 resection. CONCLUSION:We emphasised that extensive rhabdoid differentiation can be deceptive and challenging for diagnosis in small biopsies and also show an aggressive clinical course with dismal prognosis. Awareness of this rarely described unusual and aggressive histomorphological subtype is prudent due to its distinct diagnostic, prognostic and therapeutic implications.

BackgroundThe present study evaluated the real-world experience with cyclin dependent kinase 4/6 inhibitors palbociclib and ribociclib in hormone receptor-positive/ human epidermal growth factor receptor 2-negative (HR + /HER2-) metastatic breast cancer.MethodThis study was conducted on the HR + /HER2- metastatic breast cancer patients who received palbociclib/ ribociclib in the first line or recurrent setting between January 2021 and January 2023 along with endocrine therapy. Data was retrieved from the Hospital medical records.ResultsIn the patients receiving palbociclib, a better median progression free survival (PFS) was observed in patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 1 (27.3 months,p-value <0.0001), de novo disease (17.5 months,p-value 0.0155), first line hormonal therapy (22.5 months,p-value <0.0001) and no prior chemotherapy (20.3 months,p-value 0.0001). Similarly, in the patients receiving ribociclib, a better median PFS was observed in patients with ECOG PS 1 (22.2 months,p-value <0.0001), de novo disease (21.7 months,p-value 0.0042), first-line hormonal therapy (22.5 months,p-value <0.0001) and no prior chemotherapy (21.7 months,p-value <0.0001). On multivariate analysis, ECOG PS, line of hormone therapy and prior chemotherapy showed significance (p-values <0.0001, < 0.0001 & 0.0269, respectively).ConclusionThe study shows real-world experience with cyclin dependent kinase 4/6 inhibitors palbociclib and ribociclib in metastatic breast cancer in India.

293 Background: Signet ring cell carcinomas (SRC) is a well know limitation for FDG PET/CT. SRC is rich in cancer associated fibroblast hence can be imaged by FAPI PET/CT scan. This study aims to evaluate the diagnostic utility of 68Ga-FAPI PET/CT in the initial staging of signet-ring cell carcinoma (SRC) with a correlation with diagnostic laparoscopy for peritoneal metastasis. Methods: We included 29 histologically proven stomach SRC patients referred for staging work up. Both 68Ga-FAPI and 18F-FDG PET/CT scan were done with-in a week time. Diagnostic laparoscopy for peritoneal disease or any other site biopsy for metastatic site was used as a gold standard. Additionally, the single voxel maximum standard uptake value (SUVmax) of the primary, lymph node, metastasis, and SUVmean of the right lobe of the liver were recorded. SUVmax and target-to-background ratio (TBR) were compared with Wilcoxon's signed-rank test. While diagnostic effectiveness was compared with McNemar’s test. The study is ethically approved by institutional review board (RGCIRC/IRB-BHR/27/2025). Results: Out of 29 patients, FDG showed metastasis in 7 patients with diagnostic sensitivity, specificity, PPV, NPV and accuracy of 50.0%, 100%, 100%, 65%, and 74% and all these patients were also positive on FAPI scan. In remaining 22 non-metastatic patients on FDG scan, FAPI detected additional 6 patients with peritoneal metastasis. Diagnostic sensitivity, specificity, PPV, NPV and accuracy of FAPI was 85.7%, 100%, 100%, 86.6%, and 92.5% for metastasis. 13 patients were true negative on both FDG and FAPI PET for peritoneal metastasis. While 2 patients were falsely negative on both FDG and FAPI scans for peritoneal metastasis. One case was false negative in both FAPI and FDG for primary stomach lesion. 8/29 (27.5%) patients were upstaged by 68Ga-FAPI PET/CT scan in comparison to 18F-FDG PET/CT scan. Overall, FAPI PET/CT has impacted management in 24.1% of the patients in this cohort. Conclusions: 68Ga-FAPI PET/CT has higher diagnostic accuracy for metastatic workup in SRC stomach staging specially for peritoneal metastasis. Its superiority has been tailoring the diagnostic laparoscopy and guiding biopsy sites for better yield. Diagnostic statistics for metastasis for 18F-FDG and 68Ga-FAPI PET/CT scans. FDG FAPI Statistic Value 95% CI Value 95% CI Sensitivity 50.0% 23.1% to 76.9% 85.7% 57.1% to 98.2% Specificity 100.0% 75.2% to 100.0% 100.0% 75.2% to 100.0% Positive Predictive Value 100.0% 59.0% to 100.0% 100.0% 73.5% to 100.0% Negative Predictive Value 65.0% 52.3% to 75.8% 86.6% 64.3% to 95.9% Accuracy 74.0% 53.7% to 88.8% 92.5% 75.7% to 99.0%

BACKGROUND:Gallbladder carcinoma has dismal prognosis with <20 % resectability at presentation. The role of Neoadjuvant chemotherapy (NACT) remains undefined. METHODS:This is a prospective single center study of 226 gallbladder carcinoma patients receiving NACT. Gemcitabine-platinum combinations were administered followed by response assessment. Primary endpoints included resectability and survival outcomes. RESULTS:Of 226 patients, 135 (59.7 %) completed NACT. Intention-to-treat resection rate was 36.2 % (82/226), increasing to 60.7 % (82/135) among treatment completers. R0 resection achieved in 95.1 % (78/82). Grade ≥3 toxicity occurred in 9.7 % with 1.7 % treatment-related mortality. Median overall survival: 27 months (resectable) versus 13 months (unresectable) (p < 0.001). Two-year overall survival: 62.1 % versus 31.4 % respectively. Perioperative mortality: 3.7 %; major morbidity: 13.5 %. Incidental gallbladder cancer showed higher resectability (44.1 % vs 33.7 %) with 2-year overall survival 75 % versus 55.6 %. Multivariate analysis identified resectability (HR 2.714, p = 0.0002), perineural invasion (HR 2.986, p = 0.018), and advanced T-stage (HR 1.940, p = 0.041) as independent prognostic factors. CONCLUSIONS:NACT enables curative resection in 60.7 % completing treatment with acceptable toxicity, supporting incorporation into treatment algorithms for locally advanced gallbladder cancer.

Background Patients of ovarian cancer who respond to the initial chemotherapy (CT) regimen may respond again to the same drugs after relapse. We aimed to evaluate the survival of patients with recurrent ovarian cancer (ROC) treated with second-line CT drugs such as liposomal doxorubicin, paclitaxel/carboplatin, and/or bevacizumab. Methods Electronic medical records of ovarian cancer patients registered between January 2009 and December 2017 were reviewed to identify those with ROC. Data regarding demographics, clinical characteristics, treatment, recurrence, vital status at last contact, etc. were retrieved. The log-rank test was applied to compare the Kaplan-Meier curves for survival analysis. Results A total of 119 cases met the inclusion criteria. The median age at diagnosis and relapse was 49 and 51 years, respectively. The medians for progression-free survival (PFS) and post-relapse survival (PRS) were 19 (95% CI 10.34-21.66) months and 34 (95% CI 37.17-56.83) months, respectively. The PFS was significantly higher among premenopausal women (p=0.025). Patients treated with paclitaxel/carboplatin-based second-line CT had significantly higher PRS compared to those treated with liposomal doxorubicin/carboplatin (p<0.001). Overall survival was also significantly different between the stage groups (p=0.003). Conclusions The 5-year PFS rate in ROC treated with second-line CT is <20%. The rate of secondary recurrence is moderately high, leading to reduced survival. Paclitaxel/carboplatin-based second-line CT significantly increases PRS among ROC patients. The probability of mortality increases as the stage advances.

BACKGROUND Renal cell carcinoma (RCC) demonstrates extensive genomic heterogeneity. While major sequencing projects like The Cancer Genome Atlas have defined key molecular causes; real-world genomic data from Indian population is limited. This study intends to define the mutational landscape of RCC in an Indian tertiary cancer center and to evaluate the clinical actionability of identified alterations using the European Society for Medical Oncology Scale for Clinical Actionability of Molecular Targets (ESCAT). AIM To characterize the genomic landscape of RCC in an Indian real-world cohort using targeted next-generation sequencing (NGS) and to evaluate the clinical actionability of detected alterations according to the ESCAT. METHODS This retrospective real-world investigation included 48 patients with pathologically diagnosed RCC who underwent tumor genomic profiling with a focused 14-gene NGS panel encompassing chromatin-remodeling genes, DNA damage repair (DDR) pathways, and the PI3K-AKT-mTOR signaling axis. Clinicopathological features were collected and genetic changes were categorized by ESCAT tiers to assess potential clinical significance. RESULTS The cohort comprised 75% males with a median age of 58 years. Clear cell RCC (ccRCC) was the most common histology (81.3%) and advanced disease (American Joint Committee on Cancer stage III/IV) was found in 56.2% of patients. The most frequently altered genes were VHL (35.4%), PBRM1 (25.0%), SETD2 (14.6%), ATM (12.5%), and TP53 (12.5%). In the ccRCC subgroup (n = 39), mutation frequencies for VHL and PBRM1 were 38.5% and 25.6%, respectively. The most prevalent co-alteration pattern was VHL-PBRM1 mutations (n = 6). ESCAT analysis showed potentially actionable alterations in 18.8% of cases, mostly Tier II/III variants in the PI3K-AKT-mTOR pathway (MTOR, TSC1/TSC2, PIK3CA) and Tier III/IV alterations in DDR genes. CONCLUSION This study delineates the real-world genomic landscape of RCC in an Indian cohort, confirming key chromatin-remodeling alterations characteristic of ccRCC while suggesting relatively higher frequencies of ATM and TP53 mutations. Although targeted NGS provides important molecular insights, the proportion of high-tier actionable alterations remains limited, underscoring the need for broader genomic profiling and biomarker-driven studies in this population.

BACKGROUND:Only few retrospective studies have investigated ability of PET-CT to diagnose distant metastases in incidental GBC with variable results. This prospective study aims to determine utility of PET-CT in potentially-resectable IGBC. METHODS:All IGBC patients (stage ≥ T1b) with resectable disease on CECT chest, abdomen & pelvis were subjected to FDG-PET-CT. All additional findings and change in management plan were recorded. RESULTS:Out of 118 patients, 78 (66.10%) were females with mean age of 55.6 years. After PET scan, additional findings were seen in 46/118 patients leading to change in management plan in 32 (27.12%) patients due to presence of distant metastases, most common site being distant LN in 15 (46.8%) followed by omento-peritoneal disease in 7 (21.8%) patients. After assessment on CECT, 63 patients were planned for NACT in view of locally advanced disease but after PET-CT, management plan changed to palliative chemotherapy in 24 (38.09%) of these cases whereas it changed in only 8 of 55 (14.5%) patients initially planned for upfront surgery (p = 0.0065). Sensitivity, specificity, PPV and NPV of PET for distant metastases was found to be 84.21%, 70.83%, 69.57% and 85% respectively with diagnostic accuracy of 76.74%. The diagnostic accuracy was 86%, 97.67% and 93% for diagnosis of distant LNs, liver and peritoneal metastasis respectively. CONCLUSION:FDG PET-CT is a valuable preoperative staging adjunct for IGBC as it changed management plan in more than one-fourth of all resectable patients and in more than one-third of locally advanced cases. It must not, however, be viewed as a standalone gateway; rather, it should be followed by a mandatory staging laparoscopy to rule out occult peritoneal dissemination.

Background and objectives:The 2 techniques for liver resection during radical cholecystectomy for gallbladder cancer (GBC) are: nonanatomical wedge resection (wedge) and anatomic segment 4b+5 resection (4b/5). There is a lack of prospective studies and randomized controlled trials (RCT) comparing these 2 techniques. So we conducted this RCT to compare these 2 techniques with respect to surgical and oncological outcomes.Patients and methods:It was a single-center, phase 3, balanced allocation (1:1), and open-label RCT. Patients undergoing surgery for GBC were randomized intraoperatively to wedge or segment 4b/5 resection after ruling out metastatic or unresectable disease.Results:A total of 163 patients were included in final analysis (4b/5=83, wedge=80). Both the groups were similar in baseline characteristics. Segment 4b/5 group had significantly longer duration of surgery (318 vs. 287 min, P=0.009) and higher blood loss (265 mL vs. 223 mL, P=0.05). But there was no difference in morbidity, mortality, and R0 resection rates. At a median follow-up of 27 months mean DFS for segment 4b/5 and wedge group was 41.8 months and 44.7 months, respectively (HR: 0.8, 95% CI: 0.47-1.4, P=0.50). Mean OS for segment 4b/5 and wedge group was 45.3 months and 50.7 months, respectively (HR:0.6, 95% CI: 0.36-1.14, P=0.12).Conclusions:Anatomic segment 4b/5 resection and wedge resection had similar morbidity, mortality, DFS, and OS. So type of liver resection in radical cholecystectomy did not have any impact on long-term oncological outcomes.

Background Accurate assessment of hepatic reserve is essential in hepatocellular carcinoma (HCC). While the Child-Pugh (CP) score remains widely used, subjectivity in its parameters limits reproducibility. The Albumin-Bilirubin (ALBI) score offers an objective alternative, but contemporary Indian data comparing the two remain limited. Aim To compare the prognostic performance of the Child-Pugh (CP) score, the ALBI score, and the modified ALBI (mALBI) grade in predicting survival outcomes among patients with hepatocellular carcinoma treated at a North Indian tertiary cancer center using an extended follow-up dataset. Methods This retrospective cohort included consecutive patients diagnosed with HCC between January 2020 and December 2024. Eligibility required radiologic or histologic HCC and baseline CP class A or B. ALBI and CP scores were calculated at diagnosis. Survival analysis was censored on June 30, 2025, providing mature overall survival (OS) and progression-free survival (PFS) data (median follow-up 24.0 months). Kaplan-Meier methods, Cox regression, Harrell's C-index, and time-dependent receiver operating characteristic (ROC) analyses were performed. Results A total of 210 patients were included. ALBI grade distribution was ALBI-1 in 67 patients (31.9%), ALBI-2 in 125 patients (59.5%), and ALBI-3 in 18 patients (8.6%). Child-Pugh classification showed CP-A in 155 patients (74.0%) and CP-B in 55 patients (26.0%). Median OS for the cohort was 14.2 months (95% CI: 11.8-16.9), and median PFS was 9.5 months (95% CI: 7.8-11.4). ALBI demonstrated superior prognostic discrimination compared with Child-Pugh classification (C-index 0.68 vs. 0.61, p=0.024), while modified ALBI showed the highest discriminatory performance (C-index 0.71). ALBI also identified significant prognostic heterogeneity within CP-A patients that was not captured by Child-Pugh classification. Conclusion In this retrospective single-center cohort, the ALBI score demonstrated better prognostic discrimination than the Child-Pugh score, particularly among patients with Child-Pugh class A liver function. These findings support consideration of ALBI as an objective tool for risk stratification in HCC; however, prospective multicenter studies are needed to validate its broader clinical application.

In a real-world setting, this study evaluated clinical parameters and outcomes with the administration of eribulin in heavily pre-treated Indian metastatic breast cancer (MBC) patients using electronic medical records. Among 145 patients, 46.2% were oestrogen/progesterone receptor-positive, 15.9% had HER2-overexpression, and 46.2% had triple-negative breast cancer (TNBC). Eribulin was administered as a 2nd, 3rd, 4th, and ≥5th line chemotherapy in 11.7%, 18.6%, 30.3%, and 39.3% patients, respectively. Grade ≥3 neutropenia occurred in 26.2% of patients. After six cycles, 1.8% had complete response, 17.5% partial response, 17.5% stable disease, and 57.9% experienced disease progression. The overall response rate was 7.6%. Median progression-free survival and overall survival were 3.9 and 11.6 months, respectively. Overall, the study shows low response rate with manageable toxicity. The findings highlight the need for further focused studies comparing eribulin with existing chemotherapies, especially in the Indian patients with disease heterogeneity and unique genetic makeup.

Purpose: This study evaluates the long-term outcomes of adjuvant radiation therapy (RT) in patients with penile cancer treated over 14 years. Methods and Materials: In this retrospective cohort study, patients with squamous cell carcinoma of the penis who underwent surgery followed by adjuvant RT with or without concurrent chemotherapy from January 2010 to December 2022 were included, with follow-up continuing until December 2023. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS), with additional analyses of toxicity and recurrence patterns. Survival rates were estimated using the Kaplan-Meier method, and univariate analysis was performed using Cox proportional hazards regression to assess the associations between clinical variables and outcomes (OS and RFS). Hazard ratios with 95% CIs were calculated, and a P value of <.05 was considered statistically significant. Results: A total of 30 patients met the selection criteria. The median age was 57 years (IQR, 52-63), with a median follow-up of 84 months (95% CI, 74.02-92.81 months). The median OS was 77.2 months, while the median RFS was not reached. Five-year and 7-year survival rates were 52% and 46%, respectively. The 5-year RFS was 66%. Among 8 patients with recurrence, 6 had locoregional and 2 had distant metastasis. RT was generally well tolerated, with lymphedema as the most common side effect. Conclusions: Despite adjuvant RT, survival outcomes remain suboptimal, with high rates of locoregional relapse. These findings underscore the need for improved treatment strategies.

Background Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy with limited effective systemic therapies. Modified FOLFIRINOX (mFOLFIRINOX) and gemcitabine plus nab-paclitaxel (GN) are commonly used first-line regimens. The purpose of this study is to evaluate real-world efficacy (response rates, progression-free survival (PFS) and overall survival (OS)) and toxicity (grade 3/4 hematologic and non-hematologic toxicities) of first-line mFOLFIRINOX and gemcitabine plus nab-paclitaxel in patients with advanced pancreatic ductal adenocarcinoma. Methods We conducted a retrospective analysis of 64 patients with advanced PDAC treated between May 2023 and May 2025. Thirty patients received GN, and 34 received mFOLFIRINOX. Efficacy outcomes included overall response rate (ORR), clinical benefit rate (CBR), PFS, and OS. Toxicities were graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Statistical analyses included Kaplan-Meier survival estimates and Cox regression modeling. Results The median age was 59 years (range: 32-75), with a predominance of male patients (68.2%). Most had Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1 (89.1%). Patients receiving mFOLFIRINOX were younger and more likely to have tumors in the pancreatic head, whereas elevated CA19-9 levels were more common in the GN group. ORR was 57% in the GN arm and 52.9% with mFOLFIRINOX (P=0.179), while CBR was comparable (77% vs. 76.5%, P=0.985). The median progression-free survival of patients receiving GN was 6.97 months and 8.5 months with FOLFIRINOX (HR: 1.14; 95% CI: 0.58 - 2.22; P=0.713). mFOLFIRINOX had a median overall survival benefit (HR: 1.352; 95% CI 0.63 - 2.90; P=0.428), but this did not reach statistical significance. One-year OS was higher with mFOLFIRINOX (91.6% vs. 82.4%), as was 1.5-year OS (76.3% vs. 55.0%). Paradoxically, one-year PFS favored GN (32.5% vs. 20.3%). Grade 3/4 hematologic toxicities were more frequent with mFOLFIRINOX (e.g., neutropenia: 20% vs. 8.8%, anemia: 20% vs. 5.9%). GN was associated with more grade 3/4 vomiting (38.2% vs. 10%, P=0.009), diarrhea (26.5% vs. 3.3%, P=0.011), and neuropathy (29.4% vs. 6.7%, P=0.02). Dose modifications and treatment delays were similar, though delays were more frequent in the mFOLFIRINOX arm. Conclusions Both mFOLFIRINOX and GN demonstrated comparable efficacy in real-world treatment of advanced PDAC. mFOLFIRINOX offered better long-term OS but carried a higher risk of hematologic toxicity, while GN was associated with greater gastrointestinal and neurological adverse effects. Treatment selection should be guided by patient-specific factors such as comorbidities and tolerance to toxicity. Sequential treatment planning, including access to second-line therapy, significantly impacts survival and should be integral to care strategies.

Pancreatic cancer needs a multidisciplinary approach to treatment. These consensus statements encompass all aspects of treatment of pancreatic cancer within the Indian context. This article outlines consensus-based Indian guidelines for pancreatic cancer (PC), created by a national panel of 39 experts using NCCN and ESMO frameworks. Recommendations were systematically developed via evidence review, expert discussion, and conflict-of-interest exclusions. Guidance covers standardized diagnostic workup, risk stratification and multidisciplinary management involving surgical oncology, medical oncology and radiation oncology. Tumor subtypes (resectable, borderline resectable, locally advanced) determine treatment pathways: upfront surgery for eligible patients and neoadjuvant therapy for downstaging, as appropriate. Preferred regimens for advanced/metastatic disease are outlined. Recommendations are tailored to Indian practice, integrating resource stratification and local access issues. Each guideline is graded for evidence strength and consensus level as per ESMO standards. Emphasis on surveillance and early integrated palliative care aims to optimize patient outcomes. These evidence-based guidelines seek to standardize and elevate PC care across diverse settings in India.

BACKGROUND AND OBJECTIVES:The 2 techniques for liver resection during radical cholecystectomy for gallbladder cancer (GBC) are: nonanatomical wedge resection (wedge) and anatomic segment 4b+5 resection (4b/5). There is a lack of prospective studies and randomized controlled trials (RCT) comparing these 2 techniques. So we conducted this RCT to compare these 2 techniques with respect to surgical and oncological outcomes. PATIENTS AND METHODS:It was a single-center, phase 3, balanced allocation (1:1), and open-label RCT. Patients undergoing surgery for GBC were randomized intraoperatively to wedge or segment 4b/5 resection after ruling out metastatic or unresectable disease. RESULTS:A total of 163 patients were included in final analysis (4b/5=83, wedge=80). Both the groups were similar in baseline characteristics. Segment 4b/5 group had significantly longer duration of surgery (318 vs. 287 min, P =0.009) and higher blood loss (265 mL vs. 223 mL, P =0.05). But there was no difference in morbidity, mortality, and R0 resection rates. At a median follow-up of 27 months mean DFS for segment 4b/5 and wedge group was 41.8 months and 44.7 months, respectively (HR: 0.8, 95% CI: 0.47-1.4, P =0.50). Mean OS for segment 4b/5 and wedge group was 45.3 months and 50.7 months, respectively (HR:0.6, 95% CI: 0.36-1.14, P =0.12). CONCLUSIONS:Anatomic segment 4b/5 resection and wedge resection had similar morbidity, mortality, DFS, and OS. So type of liver resection in radical cholecystectomy did not have any impact on long-term oncological outcomes.

BACKGROUND:Cisplatin-based chemotherapy is the standard first-line treatment for advanced urothelial carcinoma of the bladder. Many patients cannot receive cisplatin due to advanced age, renal insufficiency, and poor performance status. As an alternative, gemcitabine-carboplatin (GCa) is frequently used, yet the comparative efficacy of GCa vs. gemcitabine-cisplatin (GC) in real-world settings remains uncertain. METHODS:We conducted a retrospective analysis of 100 patients with advanced urothelial carcinoma who received either GC (n=60) or GCa (n=40) from January 2022 to December 2024. The primary endpoints were progression-free survival (PFS) and overall survival (OS). The secondary endpoints were objective response rate (ORR), disease control rate (DCR), and side effects of therapy. Kaplan-Meier methods were used to calculate survival curves. RESULTS:The median PFS was 7.6 months (GC) vs 5.4 months (GCa) (p=0.03). The median OS was 13.8 months (GC) vs 10.1 months (GCa) (p=0.04). The ORR was higher in the GC group (GC, 42% versus GCa, 30%), but not statistically significant (p=0.08). Renal toxicity (grade 3/4) was higher in the GC group (18% vs 6%, p=0.02). CONCLUSION:GC demonstrates improved efficacy compared to GCa in terms of PFS and OS, although this comes with renal toxicity. GCa can be a reasonable option for patients not receiving cisplatin.

BACKGROUND:Advanced gastric cancer (AGC) has limited treatment options beyond first-line therapy. The combination of paclitaxel and ramucirumab is an approved second-line regimen. This study evaluates the real-world efficacy and safety of this combination in Indian patients. AIM:To assess the effectiveness and tolerability of paclitaxel plus ramucirumab in advanced gastric/gastroesophageal junction adenocarcinoma in a real-world setting. MATERIALS AND METHODS:This retro-prospective study included 85 patients with AGC treated between January 2020 and December 2024 at a tertiary cancer centre in North India. Patients received paclitaxel 80 mg/m² on days 1, 8, and 15, and ramucirumab 8 mg/kg on days 1 and 15 of a 28-day cycle. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. RESULTS:The median age was 58 years; 71% were male. ECOG PS 0-1 was present in 70%. Prior gastrectomy was reported in 36%. Median PFS was 5.1 months, and OS was 9.3 months. ORR was 27%, and DCR was 66%. Common grade 3/4 adverse events included neutropenia (19%), neuropathy (13%), and hypertension (9%). CONCLUSION:Paclitaxel plus ramucirumab is effective and well-tolerated as second-line treatment in Indian AGC patients. Outcomes mirror global data and support its continued use in resource-limited settings.