Avastin’s failure in a phase III trial for stomach cancer demonstrates a truth about the indication: most of the marketed drugs and pipeline candidates for stomach cancer are line extensions. The five leading marketed drugs for stomach cancer – Taxotere, Xeloda, Topotecin, Furtulon and Sinofuanl – are all indicated for multiple cancer indications, and the late stage pipeline is full of candidates for which stomach cancer is a follow-on indication.

Herceptin, known primarily as a breast cancer drug, is now approved in Europe for HER2-positive stomach cancer, and in addition to Avastin’s phase III trials, Erbitux, Afinitor and Tykerb are all listed as being in Phase III to treat the indication. The only significant phase III candidate that has stomach cancer as a lead indication is Eli Lilly’s IMC-1121B (ramucirumab), a monoclonal antibody Lilly acquired through its ImClone Systems purchase, which is also in phase III trials for breast cancer.