The efficacy and safety of ramucirumab (RAM) monotherapy or in combination with paclitaxel (PTX) have been established in the phase 3 clinical trials while the effectiveness and safety in real-world settings remain uncertain.

Therefore, a systematic literature review (SLR) of real-world studies (RWSs) is necessary, particularly in Eastern Asia where gastric cancer poses a significant burden.

Effectiveness and safety results of RAM monotherapy and RAM + PTX in RWSs were generally consistent with those reported in the phase 3 clinical trials.

With the increasing use of immunotherapy plus chemotherapy as a standard of care in first-line settings for patients with advanced or metastatic gastric cancer, more extensive research is needed to confirm whether prior anti-programmed cell death 1 (anti-PD-1) exposure would enhance the effectiveness of RAM-based therapy.

More RWSs are recommended in future, especially studies from China, which has a large population of patients with gastric cancer.