Clinical Research Directory

Inclusion Criteria: * Histologically confirmed, unresectable, locally advanced or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma, whatever HER2 status * Aged ≥ 70 years * WHO \< 2 * Estimated life expectancy \> 3 months * Measurable or non-measurable disease according to RECIST 1.1 criteria * Documented progression during first-line fluoropyrimidine- and platinum- or irinotecan containing chemotherapy (with or without anthracycline), or during the 4 months following the last cycle of such chemotherapy administered for metastatic or locally advanced disease, or during the 6 months following the last dose of adjuvant therapy containing fluoropyrimidine and platinium (treatment by immunotherapy is allowed) * Adequate hepatic, renal and hematologic function: * ANC ≥ 1 500 / mm3, platelets ≥ 100 000 / mm3, hemoglobin ≥ 9 g/dL * Blood creatinine ≤ 1.5 x ULN and creatinine clearance (MDRD formula) ≥ 40 mL/min * Total bilirubin ≤ 1.5 x ULN, AST and ALT ≤ 3 x ULN (≤ 5 x ULN if hepatic metastasis) * INR ≤ 1.5 or INR ≤ 3 for patients taking AVK and PTT ≤ 5 seconds above the ULN * Dipstick proteinuria ≤ 1+ or 24 hour proteinuria \< 1 g in total * EORTC QLQ-C30 + QLQ-ELD14, completed and faxed to the Randomization, Management and Analysis Center of the FFCD * IADL geriatric questionnaire, completed and faxed to Randomization Management and Analysis Center of FFCD * Signed informed consent Exclusion Criteria: * Known cerebral metastasis * Prior treatment by taxanes * Prior treatment with an antiangiogenic * Neuropathy of grade ≥ 2 (NCI-CTCAE 4.0) * Unresolved partial or total bowel obstruction, inflammatory bowel disease (such as Crohn's disease or ulcerative colitis) or extensive gastrointestinal (GI) resection combined with chronic diarrhea * GI perforation and/or fistulae in the 6 months preceding randomization. * GI bleeding within the last 3 months of grade ≥ 3 (NCI-CTCAE 4.0) * Chronic use of antiplatelet drugs (including aspirin, but a daily intake of ≤ 325 mg/day is accepted), non-steroidal anti-inflammatory drugs (ibuprofen, naproxen), dipyridamole, clopidogrel or similar agents * Any arterial thromboembolic event (such as myocardial infarction, unstable angina, cerebrovascular accident or transient ischemic attack) in the 6 months preceding randomization * A life-threatening episode of pulmonary embolism in the 6 months preceding randomization * Deep-vein thrombosis, pulmonary embolism (PE), or any other significant thromboembolism (venous port or catheter thrombosis or superficial venous thrombosis are not considered "significant" during the 3 months prior to first dose of protocol therapy * Uncompensated congestive heart failure or uncontrolled arrhythmia * Uncontrolled hypertension (≥ 140/90 mm Hg for \> 4 weeks) despite properly observed antihypertensive therapy * Cirrhosis at a level of Chilg-Pugh B or C; or cirrhosis (any degree) with a history of hepatic encephalopathy or clinically meaningful ascites resulting from cirrhosis. Clinically meaningful ascites is defined as ascites from cirrhosis requiring diuretics or paracentesis * Serious or unhealed wound, peptic ulcer or fracture within 28 days of randomization * Radiotherapy or major surgery within 28 days of prior to first dose of protocol therapy, or minor surgery/subcutaneous venous access device placement within 7 days prior the first dose of protocol therapy * Known allergy to paclitaxel or ramucirumab * Another concomitant cancer or a history of cancer in the last 5 years, except cervical carcinoma in situ, cutaneous basal-cell or squamous-cell carcinoma, or any other carcinoma in situ deemed to be successfully treated * Lack of effective contraception in patients (man and/or women) of childbearing age, and/or their * Persons deprived of liberty or under supervision * Impossibility of undergoing medical monitoring during the trial for geographic, social or psychological reasons