Metastatic Gastric Cancer Treatment Complicated by Acute Hypertension During Ramucirumab

What happened, in summary

A 65-year-old man with well-controlled hypertension was referred for palliative treatment after exploratory laparoscopy showed peritoneal metastasis from gastric adenocarcinoma. He began first-line chemotherapy with capecitabine and oxaliplatin every 3 weeks. After 3 cycles, thrombocytopenia led to a 2-week delay and oxaliplatin was stopped. He then received 3 cycles of capecitabine alone. CT imaging subsequently showed cancer progression. He moved to second-line treatment that included ramucirumab. The first cycle was complicated by febrile neutropenia, and the day-15 treatment was withheld. Before the next cycle his blood pressure was 134/82 mm Hg. Immediately after ramucirumab infusion, he developed chills and marked hypertension, with blood pressure rising to 171/119 mm Hg while his pulse and temperature remained normal. The case focuses on this acute treatment reaction rather than on a later cancer response. At the last clearly patient-specific point in the extracted narrative, second-line therapy had been initiated after documented progression of the gastric cancer.