Ramucirumab: 22 Real Stories

Gastric cancer treatment during hemodialysis after liver recurrence

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: HER2-negative

Metastatic Site: liver|peritoneum

The cancer progressed in the peritoneum despite treatment, and systemic therapy was stopped in August 2024 before transfer to hospice in October 2024.

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MET exon 14 skipping lung adenocarcinoma: sequential MET-TKI toxicity and ongoing chemotherapy

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: MET exon 14 skipping mutation; EGFR negative; ALK negative; ROS1 negative; PD-L1 tumor proportion score 10%

Metastatic Site: pleura

The cancer recurred with pleural dissemination after surgery and adjuvant UFT. Sequential MET inhibitors and systemic therapies provided periods of disease control but were limited by ILD and non-ILD toxicities; at the report, he remained on carboplatin, pemetrexed, and bevacizumab.

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Stage IV gastric cancer with benign breast hemangioma during ramucirumab therapy

Patient Info: Anonymized, Female, Under 40 | Stage IV

Biomarkers: Gastric cancer: HER2 negative, PD-L1 TPS >=5%

Metastatic Site: peritoneum; preaortic lymph nodes; omentum

After initial response to FOLFOX/nivolumab and temporary benefit from paclitaxel/ramucirumab and FOLFIRI, the gastric cancer progressed to massive ascites. Trifluridine/tipiracil was attempted, but she died from rapid disease progression.

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Stage IV cecum cancer with liver and ovarian metastases: ramucirumab-related nephrotic syndrome and glomerular microangiopathy

Patient Info: Anonymized, Female, 50s | Stage IV

Biomarkers: Cancer biomarkers were not reported. Kidney injury workup showed severe protein leakage and biopsy-proven glomerular microangiopathy.

Metastatic Site: liver, right ovary

The liver metastasis shrank after XELOX plus bevacizumab and metastatic liver/ovarian sites were resected, but ramucirumab-based second-line therapy was stopped after nephrotic syndrome and severe glomerular microangiopathy; blood pressure and proteinuria improved with telmisartan.

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Brain radiation therapy complication (radionecrosis) potentially linked to combined chemo-immunotherapy

Patient Info: Anonymized, Female | Stage IV

Biomarkers: PD-L1 0%; tumour mutational burden 33 mutations/Mb; TP53 mutation at diagnosis; later ctDNA included KEAP1 and NOTCH3 alterations

Metastatic Site: brain; presumed leptomeningeal disease

She recovered completely from surgery for radiation necrosis, resumed cancer treatment and remained neurologically intact at 18 months. She was found deceased 9 months later; the cause of death was unknown.

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Stage IV EGFR Non-Small Cell Lung Cancer: Tiffany's Patient Story

Patient Info: Tiffany, Female | Stage IV

Biomarkers: EGFR mutation

Metastatic Site: Bone: pelvis, right femur, cervical spine

As of March 2023, Tiffany had benefited from Tagrisso plus Cyramza, but later CT findings suggested worsening disease and she had started a new early-stage clinical trial with results pending.

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Stage IV gastric cancer with a TP53 blood finding traced to clonal hematopoiesis

Patient Info: Anonymized, male, 50s | Stage IV

Metastatic Site: distant lymph nodes

At age 57, 3 years 4 months after his Stage IV diagnosis, he remained alive after multiple lines of treatment; progression had occurred before his later-line regimens.

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HER2-positive metastatic gastric cancer responding to trastuzumab deruxtecan rechallenge

Patient Info: Anonymized, male, 60s | Stage IV

Biomarkers: HER2-positive

Metastatic Site: liver

After trastuzumab deruxtecan was restarted, his symptoms improved after the first cycle and imaging showed tumor shrinkage after 3 cycles. He was still receiving treatment without progression at the latest follow-up.

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Kidney Injury During Nivolumab Treatment for Stage IV Gastric Cancer

Patient Info: Anonymized, Male, 60s | Stage IV

Kidney function and proteinuria improved after nivolumab was stopped, but the gastric cancer progressed. Restarted nivolumab was ineffective, and treatment was changed to irinotecan.

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Stage IV gastric cancer with low platelets managed so chemotherapy could continue

Patient Info: Anonymized, female, 60s | Stage IV

Chemotherapy was able to continue after partial splenic embolization, but the gastric cancer later progressed and she died from the disease.

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Stage IV gastric cancer with low platelets managed so chemotherapy could continue — Case 2

Patient Info: Anonymized, female, 70+ | Stage IV

After partial splenic embolization, her platelet count recovered and thrombocytopenia did not recur. She was receiving second-line ramucirumab plus paclitaxel at the latest follow-up.

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Stage IV gastric cancer with gastric outlet obstruction treated with a stent

Patient Info: Anonymized, female, 70+ | Stage IV

Metastatic Site: para-aortic lymph nodes

The second stent allowed her to continue eating solid food. She died from progressive gastric cancer 3 months after the repeat stent procedure.

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Ramucirumab and paclitaxel for metastatic gastric cancer in a patient receiving hemodialysis

Patient Info: Anonymized, male, 60s | Stage IV

Biomarkers: HER2-negative

Metastatic Site: liver, distant lymph nodes

After about 16 months of disease control on paclitaxel plus ramucirumab, multiple liver metastases and distant lymph nodes progressed. Third-line irinotecan was stopped after severe toxicity, and supportive care followed.

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Metastatic NRG1-Fusion Lung Cancer Responding to Long-Term Afatinib

Patient Info: Anonymized, Female, 60s | Stage Metastatic/Advanced

Biomarkers: CD74-NRG1 fusion

Metastatic Site: lungs

As of February 2020, she remained on afatinib 30 mg daily with an ongoing partial response after 27 months.

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Sjögren syndrome during nivolumab treatment for HER2-positive metastatic gastric cancer

Patient Info: Anonymized, male, 60s | Stage IV

Biomarkers: HER2-positive

Metastatic Site: liver, lungs, adrenal gland

One year after nivolumab was stopped, the shrinkage of lung metastases was maintained and the adrenal metastasis remained unchanged, although severe dry-mouth symptoms from treatment-related Sjögren syndrome persisted.

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Graves disease during nivolumab treatment for HER2-positive metastatic gastric cancer

Patient Info: Anonymized, male, 60s | Stage IV

Biomarkers: HER2-positive

Metastatic Site: liver, brain

After progression through several treatment lines and development of brain metastasis, he died 4 months after evaluation for nivolumab-associated Graves disease, more than 1.5 years after his Stage IV gastric-cancer diagnosis.

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Nivolumab-related IgA kidney disease during treatment for Stage IV gastric cancer

Patient Info: Anonymized, male, 70+ | Stage IV

The gastric tumor regrew while nivolumab was withheld. Kidney function improved with steroids, but recurrent pneumonia and poor performance status prevented immunotherapy from restarting.

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Clival skull-base metastasis during treatment for Stage IV gastric cancer

Patient Info: Anonymized, male, 70+ | Stage IV

Biomarkers: HER2-negative

Metastatic Site: peritoneum, cervical lymph nodes, pelvic bone, lungs,…

At publication he was alive on fourth-line treatment, with no disease progression for 6 months after the clival metastasis was treated and with sustained improvement in his cranial-nerve symptoms.

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Stage IV gastric cancer complicated by paraneoplastic dermatomyositis during nivolumab treatment

Patient Info: Anonymized, male, 70+ | Stage IV

Metastatic Site: liver, lung, abdominal cavity

He died from rapidly worsening gastric cancer 142 days after the first nivolumab dose, roughly 14 months after his April 2017 diagnosis.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Treatment Intolerance and Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation

After poorly tolerated earlier regimens with stable disease, he developed symptomatic progression during 1 month of afatinib.

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Metastatic Gastric Cancer Treatment Complicated by Acute Hypertension During Ramucirumab

Patient Info: Anonymized, male, 60s

After progression on first-line chemotherapy, he had started second-line ramucirumab-based treatment when an acute hypertensive infusion reaction was documented.

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Recurrent Gastric Cancer With Peritoneal Spread and Acute Hypertension During Ramucirumab

Patient Info: Anonymized, male, 70+ | Stage IV

Metastatic Site: peritoneum

Treatment was stopped after 2 cycles because of progression, no further cytotoxic treatment was started, and he died at home 19 weeks after the last chemotherapy.

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