Potential risk of ramucirumab-induced liver failure associated with prior use of oxaliplatin in patients with metastatic gastric cancer: a case report

In inoperable gastric cancer, anti-angiogenic therapy with ramucirumab in combination with paclitaxel has been widely used for patients who have progressed after first-line platinum and fluoropyrimidine doublet chemotherapy. Unless underlying hepatic dysfunction exists, the incidence of ramucirumab-related hepatic toxicity is extremely low. However, prior use of a hepatotoxic anticancer drug may trigger liver injury, resulting in ramucirumab-induced hepatic failure. Herein, we report a case of metastatic gastric cancer treated with second-line ramucirumab and showed signs of hepatic encephalopathy. The patient had no definite evidence of hepatic dysfunction at the start of treatment, and was previously treated with first line oxaliplatin-combined chemotherapy. It was assumed that the deteriorated hepatic environment from oxaliplatin treatment may have led to ramucirumab-induced hepatic injury. Since selecting ramucirumab as a sequential therapy after use of oxaliplatin is a standard of care, it is important to monitor signs of hepatic failure during use of ramucirumab.