Abstract: Objective This study aimed to explore the efficacy and safety of ramucirumab in Chinese patients with advanced gastric cancer / gastroesophageal junction cancer(GC/GEJC)using real world data,and analyze the impact of different clinical characteristics and combination treatment regimens on patient survival. Methods This was a dual-center,retrospective real world study involving 72 patients with advanced GC/GEJC who received ramucirumab treatment at Shanxi Medical University Cancer Hospital and Harbin Medical University Cancer Hospital from July 2017 to January 2024.Overall survival(OS)was the primary endpoint,while progression free survival(PFS)and other outcomes served as secondary endpoints.Survival analysis methods were employed to evaluate and compare OS and PFS,and Cox proportional hazards model was used to analyze influencing factors of OS and PFS. Results The median PFS was 4.27 months(95% CI:3.38-5.15 months),and the median OS was 9.66 months(95% CI:7.09-12.23 months)for all patients.Among 49 evaluable patients,the objective response rate(ORR)was 16.3%,and the disease control rate(DCR)was 67.4%.Multivariate Cox regression analysis showed that ramucirumab combined with immune checkpoint inhibitor(ICI)was an independent risk factor for OS(HR=4.600,95% CI:1.700-12.452,P=0.003),while male(HR=0.282,95% CI:0.116-0.685,P=0.005)and a history of prior surgery(HR=0.401,95% CI:0.184-0.876,P=0.022)were independent protective factors for OS.In terms of safety,75.0%(54/72)of patients experienced adverse events,with neutropenia(8.3%)being the most common grade 3-4 adverse event.No new safety signals were identified. Conclusion This real world study confirms that ramucirumab demonstrates consistent efficacy and a manageable safety in patients with advanced GC/GEJC as observed in pivotal clinical trials.However,ramucirumab combined with ICIs may be associated with reduced survival,necessitating cautious assessment of patient suitability and potential confounders in clinical practice,with further prospective research required for validation.

Key words: advanced gastric cancer, advanced gastroesophageal junction cancer, ramucirumab, real world study