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Aortic dissection after ramucirumab infusion
  1. Davide Zenoni1,
  2. Flavio Niccolò Beretta2,
  3. Vanessa Martinelli1,
  4. Alessandro Iaculli3,
  5. Maria Teresa Benzoni Fratelli1,
  6. Delia Bonzi1
  1. 1 Hospital Pharmacy Department, ASST Bergamo EST, Alzano Lombardo, Italy
  2. 2 Scuola di Specializzazione Farmacia Ospedaliera, Università degli Studi di Milano, Milan, Italy
  3. 3 Oncology Department, ASST Bergamo EST, Seriate, Italy
  1. Correspondence to Dr Davide Zenoni, Hospital Pharmacy, ASST Bergamo EST, Alzano Lombardo, Italy; davide.zenoni{at}


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.

  • adverse effects
  • chemotherapy
  • gastrointestinal tumours
  • cardiology
  • oncology

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