Transient vocal fold lesion and hoarseness associated with the use of ramucirumab: Case report

Abstract

Introduction: Gastric cancer (GC) is among the leading neoplasms with highest morbidity and mortality in the world. Tumor angiogenesis represents one of important targets of antineoplastic treatment, as it has an important role in cell development and growth.

Case report: Ramucirumab, an IgG1 monoclonal antibody (MoAb), inhibits the angiogenesis pathway by blocking the VEGFR-2 activation. The most common adverse events associated with angiogenic inhibitors are cardiovascular and healing disorders, such as systemic arterial hypertension (HTN), thromboembolism, bleeding, wound healing delay and fistulas. We report a case of vocal fold lesion associated with ramucirumab in a patient with metastatic gastric cancer. The patient presented with transient hoarseness that was related to the exposure to ramucirumab.

Discussion: Laryngeal toxicity due to anti-angiogenic agents is rare. Despite the fact that this adverse event is not a life-threatening complication, it can significantly impair quality of life and should be promptly recognized.

Keywords: Angiogenesis; Dysphonia; Larynx; Ramucirumab; Vocal folds.