Olaparib and Ramucirumab in Treating Patients With Metastatic or Locally Recurrent Gastric or Gastroesophageal Junction Cancer That Cannot Be Removed by Surgery

Inclusion Criteria

• The patient must have histologically confirmed, gastric carcinoma, including gastroesophageal junction (GEJ) adenocarcinoma (patients with adenocarcinoma of the distal esophagus are eligible if the primary tumor involves the GEJ)
• The patient has metastatic disease or locally recurrent, unresectable disease
• The patient must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1
• The patient must have experienced disease progression during or within 4 months after the last dose of chemotherapy for metastatic disease, during or within 6 months after the last dose of adjuvant chemotherapy, or have been intolerant of previous chemotherapy
• The patient must have experienced disease progression or intolerance as outlined above after treatment with 1 or more prior chemotherapies
• All previous treatments are acceptable as long as they did not contain bevacizumab, ramucirumab or PARP inhibitors
• Elevation in tumor markers without radiographic evidence of disease progression is not satisfactory for progression on previous treatment
• The patient is >= 18 years of age
• The patient has a life expectancy of >= 16 weeks
• Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1 (Karnofsky >= 60%)
• Hemoglobin >= 10 g/dL with no blood transfusions (packed red blood cells and platelet transfusions) in the past 28 days (within 28 days prior to administration of study treatment)
• White blood cells (WBC) > 3 x 10^9/L (within 28 days prior to administration of study treatment)
• Absolute neutrophil count (ANC) >= 1.5 10^9/L (within 28 days prior to administration of study treatment)
• Platelet count >= 100 X 10^9/L (within 28 days prior to administration of study treatment)
• No features suggestive of myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML) on peripheral blood smear or bone marrow biopsy, if clinically indicated (within 28 days prior to administration of study treatment)
• Total bilirubin = = 60 mL/min/1.73 m^2 (within 28 days prior to administration of study treatment)
• Proteinuria with urinary protein = 1 year ago
• Chemotherapy-induced menopause with > 1 year interval since last menses
• Surgical sterilization (bilateral oophorectomy or hysterectomy)
• The effects of olaparib and ramucirumab on the developing fetus are unknown; for this reason, women of child-bearing potential and men must agree to use adequate contraception including hormonal, barrier, or abstinence; contraception must be started prior to study enrollment; female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to treatment; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; both men and women treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study participation, and for 3 months after completion of olaparib and ramucirumab administration; male patients and their partners, who are sexually active and of childbearing potential, must agree to the use of two highly effective forms of contraception in combination, throughout the period of taking study treatment and for 3 months after last dose of study drug(s) to prevent pregnancy in a partner
• Ability to understand and the willingness to sign a written informed consent document
• The patient must be willing to undergo a biopsy prior to treatment, an on treatment biopsy at week 16 is optional if felt to be safe in the opinion of the investigator
• For inclusion into optional exploratory genetic and biomarker research, patients must fulfill the following criteria:
• Provision of informed consent for genetic research
• Provision of informed consent for biomarker research
• If a patient declines to participate in the optional exploratory genetic research or the optional biomarke