1474P Immune-inflammatory Indexes and BMI As Predictors of Outcome and Treatment Response in Advanced Gastric Cancer Receiving Ramucirumab-Containing Second-Line

The efficacy of Ramucirumab in the treatment of advanced gastric cancer was demonstrated in the two pivotal study REGARD and RAINBOW, which both demonstrated significant improvements in Overall Survival (OS) and Progression-Free Survival (PFS). However, data on validated clinical and biochemical predictive factors in a real-life setting are still lacking. Retrospective analysis of medical records of patients with advanced gastric cancers treated with ramucirumab or ramucirumab/paclitaxel from April 2015 to April 2020 at Modena Cancer Center was conducted. Clinicopathological and biochemical parameters deemed of interest were collected. The cut-off value for continuous variables was assessed at 75° percentile. Treatment effects were evaluated by univariate and multivariate Cox proportional hazards regression models for OS and logistic regression analysis. During the study period, 49 patients with advanced gastric cancers were treated with ramucirumab alone (6.1%) or in combination with paclitaxel (93.9%) as second line therapy. At the multivariate, only CEA showed to impact on the second-line PFS with statistical significance (p=0.013, 95% Confidence Interval [CI] 1.08-6.4). By performing a logistic regression analysis, Absolute Neutrophil Count (ANC), Neutrophil Lymphocyte Ratio (NLR), Systemic Inflammatory Index (SII), CEA, Body Mass Index (BMI), ECOG Performance Status and Clinical Benefit (defined as complete response, partial response and stable disease versus disease progression) showed to be correlate with a PFS of more than 6 months. ECOG 0 and BMI>25 were the main predictive factors associated with Clinical Benefit (p=0.018 and p= 0.0006, respectively). Favorable inflammatory indexes, CEA, BMI and ECOG confer a better second-line PFS. ECOG and BMI seem to be strictly related to Clinical Benefit, thus making these two parameters predictive of response to Ramucirumab. In the future, it will be mandatory a validation of our results on a larger population by the use of more specific parameters for the sarcopenia assessment.