The development of new anti-angiogenic agents targeting the
vascular endothelial growth factor (
VEGF) and
epidermal growth factor receptor pathways has greatly expanded the therapeutic options for patients with metastatic
colorectal cancer (mCRC). Although these new agents have considerably improved survival outcomes compared with conventional chemotherapeutic regimens, the optimal integration of these drugs into the management of patients with mCRC continues to develop. One particular challenge is the identification of patient subgroups that will benefit from treatment with a specific targeted agent. In RAISE, a phase III randomized, placebo-controlled clinical trial, the
VEGF receptor 2 antagonist
ramucirumab in combination with
fluorouracil plus
leucovorin and
irinotecan demonstrated efficacy as a second-line treatment for patients with mCRC.
Ramucirumab is approved for the treatment of patients with mCRC in Taiwan but, due to lack of reimbursement, is often reserved for use as a third-line or later treatment. This narrative review of prespecified and post-hoc analyses of the RAISE study data, and data from other
ramucirumab trials and real-world studies, summarizes the efficacy and tolerability of
ramucirumab in the second-line treatment of different subpopulations of patients with mCRC. The aim was to identify patients most likely to benefit from treatment with second-line
ramucirumab, with a view to illustrating the potential benefit of integrating this regimen into Taiwanese or Asian treatment practice.