Non-perforating inflammatory colitis following ramucirumab plus docetaxel therapy in a patient with non-small cell lung cancer: a case report and review of the literature

Abstract Background Ramucirumab (RAM) plus docetaxel (DTX) therapy is used as a second-line or later treatment for advanced or recurrent non-small cell lung cancer. Although severe gastrointestinal disorders, including gastrointestinal perforation, have been reported as RAM-associated adverse events, reports of non-perforating colitis following RAM administration are rare. Case Presentation A 52-year-old man was diagnosed with right upper lobe lung adenocarcinoma harboring an epidermal growth factor receptor (EGFR) exon 20 insertion mutation. Following progression on carboplatin, pemetrexed, and amivantamab, RAM plus DTX therapy was initiated during a scheduled hospitalization. On day 3 of the first cycle, the patient developed grade 3 hematochezia. Colonoscopy performed on day 8 revealed edema and erosion in the sigmoid colon and anorectal region. Based on colonoscopic findings and clinical course, ulcerative colitis was suspected, and oral mesalazine therapy was initiated. Subsequent evaluation of the colonoscopic biopsy specimens and stool culture results made enteric infection unlikely. The hematochezia resolved within approximately two weeks. RAM was subsequently discontinued, and DTX monotherapy was administered for a total of four cycles from day 22 without recurrence of hematochezia while mesalazine was continued. A Naranjo Adverse Drug Reaction Probability Scale score of 4 indicated a possible association between RAM and colitis. A review of the literature suggested that, among the cases identified in our search, RAM-related gastrointestinal adverse events mainly involved perforation or fistula formation. The present case represents a rare example of early-onset, non-perforating inflammatory colitis, distinct from previously reported events. Conclusions In the present case, non-perforating inflammatory colitis developed shortly after the initiation of RAM plus DTX therapy. This case suggests that the clinical spectrum of gastrointestinal adverse events associated with anti-VEGF/VEGFR therapy, including RAM, may not be limited to the more commonly reported gastrointestinal perforation and fistula formation. If hematochezia develops after the initiation of RAM plus DTX therapy, it is important to differentiate serious gastrointestinal complications, such as gastrointestinal perforation, from other causes of colitis and to carefully assess the temporal relationship between drug exposure and symptom onset while considering potential confounding factors.