Bevacizumab for ramucirumab refractory malignant pleural effusion in non-small cell lung cancer: a case report and review of the literature

// Ryobu Mori 1 , Daichi Fujimoto 1 , Munehiro Ito 1 and Keisuke Tomii 1 1 Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan Correspondence to: Daichi Fujimoto, email: // Keywords : bevacizumab, malignant pleural effusion, non-small cell lung cancer, ramucirumab, vascular endothelial growth factor Received : February 14, 2017 Accepted : May 01, 2017 Published : May 17, 2017 Abstract Malignant pleural effusion (MPE) is a major problem associated with advanced non-small cell lung cancer for which an optimum treatment strategy has yet to be determined. Notably, vascular endothelial growth factor (VEGF) signaling has been found to influence MPE, and bevacizumab, a VEGF ligand inhibitor, can effectively control MPE. Ramucirumab, a human monoclonal antibody specific for VEGF receptor-2, has recently been approved for advanced non-small cell lung cancer. However, it remains unclear which of these agents more effectively control MPE. We describe a case of a 68-year-old man with advanced non-small cell lung cancer in whom ramucirumab plus docetaxel-refractory MPE was responsive to bevacizumab plus docetaxel combination therapy. The patient’s MPE progressed after two cycles of ramucirumab plus docetaxel second-line chemotherapy. After switching to bevacizumab plus docetaxel, a computed tomography scan revealed a decreased MPE after two cycles of treatment. Bevacizumab may be more effective for treating MPE. However, further investigations are still warranted to determine the optimal VEGF-targeted agent for this condition.