RAINBOW

RAINBOW, trial NCT01170663 sponsored by Eli Lilly and reported in Lancet Oncology in 2014, made ramucirumab plus paclitaxel the standard second-line treatment for advanced gastric and gastro-oesophageal junction cancer, a role it held for a decade until trastuzumab deruxtecan and Claudin 18.2 drugs arrived. It randomised 665 patients to ramucirumab or placebo with paclitaxel and met its primary overall survival endpoint, and with REGARD, which tested ramucirumab alone, it established VEGFR2 blockade in gastric cancer. OnCo links it to gastric cancer, VEGF as a target, ramucirumab, paclitaxel and Min-Hee Ryu, and the result is consistent with REGARD and RAINBOW-Asia. It remains the second-line standard for HER2-negative disease and the comparator in DESTINY-Gastric04 and CLARITY-Gastric01, and how long it keeps that role is the open question.