First country in ASEAN to approve the new biologic therapy that extends survival in patients with advanced stomach cancer after prior chemotherapy
SINGAPORE, 13 December 2016 - CYRAMZA® (ramucirumab) is now available to Singaporeans living with advanced gastric cancer. The drug gained approval by Singapore's Health Science's Authority (HSA) earlier this year, marking the first (1st) regulatory approval in ASEAN. CYRAMZA is already available to patients in Japan, Korea, Taiwan and Hong Kong.
Gastric cancer, frequently referred to as stomach cancer, is the fifth most common cancer in the world and the third-leading cause of cancer-related deaths. There were nearly one million new cases worldwide in 2012 (631,000 men, 320,000 women), with approximately 723,000 deaths (469,000 men, 254,000 women).  In Singapore, stomach cancer ranks among the top ten most frequent cancers detected in the country in both men and women . According to Dr Matthew Ng, Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore, "The local registry estimated that during the period of 2010-2014, there were a total number of 2,547 new cases of stomach cancer and a total of 1,580 cancer deaths due to gastric cancer were reported- representing a high mortality rate. Stomach cancer was also found to be the 4th most common cause of cancer deaths in males and 5th most common cause of cancer deaths in females in Singapore." 
CYRAMZA® (ramucirumab) is a new biologic agent to show improved overall survival and progression-free survival as a single agent or in combination with paclitaxel chemotherapy in patients with advanced gastric cancer that has progressed after initial treatment - a devastating disease that is difficult to treat and for which the prognosis for patients has been poor.
CYRAMZA® marketing authorization approval by HSA was based on results from two global, randomised, double-blinded and placebo-controlled Phase III studies: RAINBOW and REGARD. RAINBOW evaluated CYRAMZA® in combination with paclitaxel (a type of chemotherapy) for advanced gastric or gastro-oesophageal junction adenocarcinoma after prior chemotherapy while REGARD evaluated CYRAMZA® as a single agent in the same setting. [3,4]
Dr Yong Wei Peng, Associate Director (Research) and Senior Consultant from the Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS) explains, "What makes stomach cancer one of the most challenging diseases to treat is that patients often come to us at advanced stages where treatment options are limited. In the second-line setting, chemotherapy significantly improved the overall survival compared with best supportive care; However, the median survival with chemotherapy alone has been less than 6 months. [5,6,7] As per the RAINBOW study, CYRAMZA® used in combination with chemotherapy to treat patients who have failed prior treatment, significantly improved response rate, duration of disease control and survival when compared to chemotherapy alone." 
Dr Faiz Ansari, General Manager for Lilly Singapore, Malaysia, Indonesia and Brunei says that he is proud to be a part of this meaningful moment for the Singapore oncology field. "For more than fifty years, Lilly has been dedicated to delivering life-changing medicines and support to people living with cancer and those who care for them. Today, we are building on our commitment and marking an important milestone as we bring a new biologic agent, CYRAMZA® for the treatment of advanced stomach cancer to Singapore ahead of many other countries within the region. We hope CYRAMZA® will make a difference to the patients, their caregivers and doctors who are fighting this debilitating disease," said Dr Ansari.
- Globocan 2012 Cancer Fact Sheet. Stomach cancer estimated incidence, mortality and prevalence worldwide in 2012. https://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. (Accessed December 1, 2014).
- Singapore Cancer Registry Report (2010-2014) released by National Registry of Diseases Office (NRDO, 2015).
- Wilke et al, Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet 2014. Published online September 18, 2014 https://dx.doi.org/10.1016/S1470-2045(14)70420-6.
- Fuchs et al, Ramucirumab Monotherapy For Previously Treated Advanced Gastric Or Gastro-Oesophageal Junction Adenocarcinoma (REGARD): An International, Randomised, Multicentre,Placebo-Controlled, Phase 3 Trial. Lancet. 2013 Published online October 3, 2013 https://dx.doi.org/10.1016 /S0140-6736(13)61719-5
- Kang et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol 2012; 30: 1513-18.
- Ford et al, on behalf of the COUGAR-02 Investigators. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol 2014; 15: 78-86
- Thuss-Patience PC et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer--a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer 2011; 47: 2306-14.
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