Ramucirumab as a second line therapy for advanced HCC: a significant achievement or a wasted opportunity for personalised therapy?

Invest New Drugs. 2019 Dec;37(6):1274-1288. doi: 10.1007/s10637-019-00760-0. Epub 2019 Mar 16.


The second line treatment of hepatocellular carcinoma (HCC) has recently become an exciting area of interest since new emerging options have demonstrated survival benefits versus placebo. Unfortunately, predictive biomarkers are unavailable for these treatments. Ramucirumab, a monoclonal antibody against VEGFR-2, has demonstrated overall survival superiority against placebo as a second line therapy for patients with AFP > 400 ng/ml in the recent REACH-2 trial. This review will provide the current updated knowledge regarding the HCC cancerogenesis and angiogenic VEGF/VEGFR-2 pathways and the clinical development of ramucirumab in advanced HCC. This study will also critically assess the gaps in a previous negative phase III trial that tested other potentially useful treatments and suggest ways to modernise clinical trials and personalise therapy for advanced HCC.

Keywords: Alphafetoprotein; HCC; Ramucirumab.

Publication types

  • Review

MeSH terms

  • Animals
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Hepatocellular / drug therapy*
  • Humans
  • Liver Neoplasms / drug therapy*
  • Neovascularization, Pathologic / drug therapy*
  • Precision Medicine
  • Vascular Endothelial Growth Factor Receptor-2 / antagonists & inhibitors*


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • ramucirumab
  • Vascular Endothelial Growth Factor Receptor-2