Association between ramucirumab-related hypertension and response to treatment in patients with metastatic gastric cancer
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Giandomenico Roviello1, Silvia Paola Corona2, Andrea Giovanni Multari3, Giovanni Paganini4, Giorgio Chiriacò5, Raffaele Conca1, Roberto Petrioli6, Daniele Generali7,8, Pietro Rosellini6 and Michele Aieta1
1Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, 85028 Rionero, Vulture (PZ), Italy
2Peter MacCallum Cancer Centre, Radiation Oncology Department, Moorabbin Campus, East Bentleigh, Victoria 3165, Australia
3Unit of Medical Oncology, Department of Oncology, Ospedale San Donato, 52100, Arezzo, Italy
4Unit of general medicine, Azienda Ospedaliera “C. Poma” Presidio ospedaliero di Pieve di Coriano, ASST Mantova, Italy
5Medical Oncology Unit, Department of Oncology, ASST del Garda, 25015 Desenzano del Garda (BS), Italy
6Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, 53100, Siena, Italy
7Department of Medical, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
8Breast Cancer and Translational Research Unit, ASST Cremona, 26100 Cremona, Italy
Giandomenico Roviello, email: [email protected]
Keywords: gastric cancer; ramucirumab; hypertension
Received: January 15, 2018 Accepted: March 11, 2018 Published: April 27, 2018
Purpose. Hypertension (HTN) is frequently associated with the use of angiogenesis inhibitors targeting the vascular endothelial growth factor pathway, such as ramucirumab. The aim of this study was to retrospectively evaluate if occurrence of HTN is correlated with response to second line treatment with ramucirumab+paclitaxel for metastatic gastric cancer.
Methods. Treatment consisted of ramucirumab 8 mg/kg intravenously (iv) on days 1 and 15, plus paclitaxel 80 mg/m2 iv on days 1, 8, and 15 of a 28-day cycle. Patients received study treatment until disease progression, unacceptable toxicity, or withdrawal of consent.
Results. Thirty-four patients were retrospectively evaluated. Among these, 6 (17.6%) developed grade 3 ramucirumab-induced HTN. These patients had a better outcome than those with lesser grades events, with a progression-free survival (PFS) of 7.8 months (95% CI 4.4-not reached) versus 4.2 months (95% CI 3.1-5.2) (p=0.001). overall survival (OS) was 11.9 months (95% CI 9.3-not reached) in the grade 3 HTN group, versus 7.2 months (95% CI 5.9-10.1).
Conclusions. Despite the small number of patients and the retrospective nature of the data, our analysis showed that occurrence of ramucirumab-related HTN, in particular G3 HTN, predicts response to treatment with ramucirumab+paclitaxel in patients with metastatic gastric cancer.
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