Open AccessAortic dissection after ramucirumab infusion
Author(s) -
Davide Zei,
Flavio Niccolò Beretta,
Vanessa Martinelli,
Alessandro Iaculli,
M Fratelli,
Delia Bonzi
Publication year - 2019
Publication title -
european journal of hospital pharmacy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.313
H-Index - 14
eISSN - 2047-9964
pISSN - 2047-9956
DOI - 10.1136/ejhpharm-2019-001879
Subject(s) - ramucirumab , medicine , aortic dissection , dissection (medical) , ascending aorta , aorta , surgery , paclitaxel , cardiology , oncology , cancer
A female patient in her seventies affected by a signet-ring cell carcinoma G3pT4N3 (24/29), with lymphovascular invasion, HER2-negative. After completing three cycles of first-line systemic treatment in combination with cisplatin (CDDP) + 5-fluorouracil (5FU), a new systemic therapy line with paclitaxel + Cyramza (ramucirumab) was planned. On the day after the first administration the patient manifested a Standford type A aortic dissection (AD), with a diameter of around 6.5 cm and dissection flap originating in the ascending aorta below the brachiocephalic trunk, extended to the whole descending aorta until the carrefour. The causal relationship between adverse drug reactions and Cyramza, calculated using the Naranjo algorithm, led to a result of 'probable' correlation between ramucirumab and AD. The endothelial dysfunction associated with vascular endothelial growth factor pathway inhibitors (VPIs) would seem to be the most plausible explanation for such events: it causes thromboembolic events and cardiovascular complications.