P44-4 A case report of four patients received ramucirumab monotherapy as second-line treatment for advanced gastric cancer

Abstract

There are few reports on efficacy and safety of ramucirumab monotherapy as second-line treatment for advanced or metastatic gastric cancer in a clinical practice. This is a case report of four patients who received ramucirumab monotherapy as second-line chemotherapy for advanced or metastatic gastric cancer with in a community hospital. Patients who received ramucirumab monotherapy between April 2018 and March 2020 at our institute were enrolled in this report. Median age was 69.5 years old (range 65-81). The reason for selecting ramucirumab monotherapy for second-line treatment was poor performance status in all cases. Of four cases, three had one metastatic site (liver, peritoneum, lymph node) and one had two metastatic sites (liver and peritoneum). After a median follow up period of 118 days (range 36-236), the median PFS was 40 days (range 16-113). In three patients who had measurable lesions on CT image, only one patient with lymph node metastasis showed stable disease. The best overall responses included stable disease in one patient and progressive disease in three patients. In particular, the prognosis was poor in two patients with peritoneal metastasis. There were no serious adverse events, one patient had Grade 2 hypertension. In all cases, the reason for discontinuation of treatment was progressive disease. Third-line treatment was performed in two of four patients. The adverse events were mild and manageable, ramucirumab monotherapy could be safely performed even in patients with poor general condition. On the other hand, the effect was limited compared to ramucirumab plus paclitaxel. Ramucirumab monotherapy is one of the options for second-line therapy for patients with poor general condition, but it is important to carefully consider whether the administration of cell-killing anticancer drugs is really inappropriate.