Our experience of chemotherapy with ramucirumab in combination with paclitaxel

Abstract

Background: Anti-VEGFR2 antibody Ramucirumab has significantly increased overall survival and progression free survival as 2nd line chemotherapy of advanced or recurrent gastric cancer.(in combination with paclitaxel in RAINBOW trial, and alone in REGARD trial.) Japanese Gastric Cancer Association has delivered statement on recommendation of ramucirumab in combination with paclitaxel as a first priority treatment. However, physicians should be more aware of adverse events in the combination therapy than in conventional therapy. Now we report 8 cases treated with ramucirumab in combination with paclitaxel. Method(s): Eight patients treated with ramucirumab in combination with paclitaxel since June 2015 to January 2016 were enrolled. Their ECOG PS was 0 in 4 cases, 1 in 2 cases, and 2 in 2 cases. In all cases, HER2 testing was negative, and they had been reated with one previous chemotherapy regimen(7 cases: S-1/CDDP, 1 case: S-1 adjuvant). Total gastrectomy had been performed in 3caes. Metastatic sites were lymph nodes (5 cases), liver (3 cases), Peritoneum (3 cases), bone (3 cases), and lung (1 case) at the beginning of the therapy. Result(s): In four cases, best overall response was evaluable (partial response in 1 case, and stable disease in 3 cases). Adverse events of grade 3 or 4 defined according to the CTCAE v4.0 were hypertension (grade3, 2 cases), fatigue (grade3, 1 case), febrile neutropenia (grade3, 1 case), and gastric perforation (grade4, 1case). In 2 cases, chemotherapy was discontinued due to AEs (grade3 fatigue and grade4 gastric perforation). Conclusion(s): Chemotherapy with ramucirumab in combination with paclitaxel, which has reported to increase survival significantly, seems to have more severe or frequent AEs than conventional regimens, therefore physicians should choose regimens properly.