Real-world validation of ECOG performance status and neutrophil-to-lymphocyte ratio in second-line paclitaxel plus ramucirumab for advanced gastric cancer.

Advanced gastric cancer (AGC) has a poor prognosis; better second-line options are needed. We retrospectively reviewed 130 AGC patients treated at one center with paclitaxel 80 mg/m (days 1, 8, 15) plus ramucirumab 8 mg/kg (days 1, 15) every 28 days after failure of platinum/fluoropyrimidine therapy. Kaplan-Meier curves estimated overall (OS) and progression-free survival (PFS); Cox models identified prognostic factors. Median OS was 8.3 months (95 % CI 6.9-9.7) and median PFS 4.2 months (95 % CI 3.3-5.1); 12-month OS was 31.8 %. Objective response and disease-control rates were 19.2 % and 50.0 %, respectively. Grade ≥ 3 toxicity occurred in 33 % of patients, mainly neutropenia (19 %) and neuropathy (14 %). Multivariable analysis linked longer OS to ECOG 0-1 (HR 0.54,  = 0.011) and a low neutrophil-to-lymphocyte ratio (HR 0.59,  = 0.017). In this real-world single-center cohort, paclitaxel plus ramucirumab provided clinically meaningful benefit with manageable toxicity. ECOG performance status and NLR confirmed their prognostic value in this real-world cohort. Further multicenter studies may refine patient selection and optimize outcomes. Clinically, ECOG and NLR can be used to communicate prognosis, tailor follow-up/supportive care, and stratify patients in routine practice receiving paclitaxel-ramucirumab.