Key result
Ramucirumab induced biopsy-proven renal-limited thrombotic microangiopathy in a 75-year-old woman with metastatic colorectal cancer after switching from bevacizumab, which improved upon cessation.
Why the study?
VEGF inhibitors can cause proteinuria and TMA, but whether VEGFR2 antagonism with ramucirumab can induce TMA was not yet reported.
Case Report (n=1)
No
Ramucirumab, an anti-VEGFR2 antibody, may induce renal-limited thrombotic microangiopathy, a rare but life-threatening complication.
May warrant vigilance for TMA on ramucirumab; case report leaves open incidence and monitoring needs.
BACKGROUND: It is well known that vascular endothelial growth factor (VEGF) inhibitors can cause proteinuria. The incidence of proteinuria is high for bevacizumab, a humanized monoclonal antibody directed against VEGF, but the range of proteinuria rarely becomes nephrotic (2.2% occurrence according to a meta-analysis). In such cases, renal pathology shows thrombotic microangiopathy (TMA). Ramucirumab, anti-VEGF receptor 2 (VEGFR2) monoclonal antibody, can also cause proteinuria, but it is not yet reported whether the drug may induce TMA. CASE PRESENTATION: Here, we report a case who immediately developed TMA by ramucirumab after multiple courses of bevacizumab treatment. This is the first case of pathologically-proved TMA by ramucirumab. After cessation of the drug, symptoms of TMA improved gradually. CONCLUSIONS: This case demonstrates that not only blockade of VEGF but also VEGFR2 antagonism may result in TMA, which is a rare but life-threatening complication of cancer treatment drug.
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Yamada et al. (2019) conducted a case report in Stage IV transverse colon cancer / Thrombotic microangiopathy (n=1). Ramucirumab was evaluated on Development of thrombotic microangiopathy. Ramucirumab induced biopsy-proven renal-limited thrombotic microangiopathy in a 75-year-old woman with metastatic colorectal cancer after switching from bevacizumab, which improved upon cessation.
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