Assessing Patient Risk, Benefit, and Outcomes in Drug Development: A Decade of Ramucirumab Clinical Trials

Adam Khan, Hassan Khan, Griffin Hughes, Chase Ladd, Ryan McIntire, Brooke Gardner, Andriana Pena, Abigail Schoutko, Kirstien Minley, Alyson Haslam, Vinay Prasad, Matt Vassar

Research output: Contribution to conferencePosterpeer-review



This study aims to evaluate published clinical trials of ramucirumab to assess the risk/benefit profile and burden over time for patients.


The burden of oncologic drug development on patients paired with increasing clinical trial failure rates emphasizes the need for reform of drug development. Identifying and addressing patterns of excess burden can guide policy, ensure evidence-based protections for trial participants, and improve medical decision-making.


On May 25, 2023 a literature search was performed on Pubmed/MEDLINE, Embase, Cochrane CENTRAL, and for clinical trials using ramucirumab as monotherapy or in combination with other interventions for cancer treatment. Authors screened titles and abstracts for potential inclusion in a masked, duplicate fashion. Following data screening, data was extracted in a masked, duplicate fashion. Trials were classified as positive when meeting their primary endpoint and safety, negative or indeterminate.


Ramucirumab was initially approved for gastric cancer but has since been tested in 20 cancers outside of its FDA approved indications. In our analysis of ramucirumab trials, there were a total of 10,936 participants and 10,303 adverse events reported. Gains in overall survival and progression-free survival for patients were 1.5 and 1.2 months, respectively. FDA-approved indications have reported more positive outcomes in comparison to off-label indications.


We found that FDA-approved indications for ramucirumab had better efficacy outcomes than non-approved indications. However, a concerning number of adverse events were observed across all trials assessed. Participants in ramucirumab randomized controlled trials saw meager gains in overall survival when evaluated against a comparison group. Clinicians should carefully weigh the risks associated with ramucirumab therapy given its toxicity burden and poor survival gains.
Original languageAmerican English
StatePublished - 21 Jul 2023
Event7th Annual Joint Research Meeting - Oklahoma State University Center for Health Sciences, Tulsa, United States
Duration: 21 Jul 202321 Jul 2023


Conference7th Annual Joint Research Meeting
Country/TerritoryUnited States


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