Recurrent Gastric Cancer With Peritoneal Spread and Acute Hypertension During Ramucirumab

What happened, in summary

A 71-year-old man was referred for second-line palliative treatment after recurrent gastric adenocarcinoma was found with carcinomatous peritonitis and lymphogenic spread. The recurrence appeared 3 months after he completed adjuvant chemotherapy. His earlier treatment had included 6 perioperative cycles of epirubicin, cisplatin and capecitabine. The first course was complicated by thrombosis, and epirubicin and cisplatin were withheld during the final cycle because of peripheral neuropathy. At recurrence he had poor appetite, nausea, abdominal discomfort and weight loss. He entered a compassionate-use ramucirumab program. About 20 minutes after the first infusion began, he developed facial redness and acute hypertension to 176/100 mm Hg. Steroid treatment was given and his blood pressure later normalized. On day 15, ramucirumab was infused at half the previous rate, but his blood pressure again rose, reaching 164/111 mm Hg, and amlodipine was restarted. The gastric cancer continued to progress, and ramucirumab-based treatment was stopped after 2 cycles. No further cytotoxic therapy was started. He died at home 19 weeks after his last chemotherapy.