Background: The prognosis of gastric cancer remains poor despite advances in diagnostic techniques, neoadjuvant chemo radiotherapy and surgery. This led to the development of Anti-Vascular Endothelial Growth Factor inhibitors (Anti-VEGF), which inhibit angiogenesis, inducing a state of dormancy in the tumors. In this review, we studied the safety and efficacy of Ramucirumab (RAM) and Bevacizumab (BVZ). Methods: Following the PRISMA guidelines, we searched the literature on PubMed, Cochrane, Embase & clinicaltrials.gov. A total of 311 articles were screened, and 4 studies were included. Results: When compared to placebo, in the two Phase III trials enrolling 1020 participants,RAM enhanced overall survival (OS) and progression-free survival (PFS). RAM treatment was associated with fewer hematological adverse effects, such as anemia. In addition, when administered in conjunction with CTx, bevacizumab (BVZ) improved OS (12.1m Vs 10.1m in one trial), but more clinical studies are needed to consolidate these findings. In both phase III studies with BVZ, anemia and neutropenia were shown to be less common, as shown in the table. Conclusions: Anti-VEGF inhibitors have shown to be effective in treating advanced or relapsed GC or GE CAs with minimal adverse effects. However, high-quality large prospective randomized clinical studies are still needed.

CA = Carcinoma, GC = Gastric Cancer, GE = Gastroesophageal Carcinoma, CTX = Chemotherapy, PTX = Paclitaxel, PbO = Placebo, RAM = Ramucirumab, BVZ = Bevacizumab, CAP = Capecitabine, CP = Cisplatin, A = Anemia, N = Neutropenia, T = Thrombocytopenia, AE = Adverse Events,Tot = Total number