Cyramza (ramucirumab)

Cyramza^® is a targeted therapy that is used to treat some metastatic (has spread to other parts of the body) non-small cell lung cancers (NSCLC). In combination with another targeted therapy medication, erlotinib, it is approved as a first-line treatment of metastatic NSCLC with epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) mutations.⁵

It is used in combination with the chemotherapy drug docetaxel in patients with metastatic NSCLC whose cancer has gotten worse while receiving, or after receiving, platinum-based chemotherapy. Within this category, patients with NSCLC that have EGFR or ALK gene abnormalities should have also tried treatment with approved therapy for these abnormalities, that stopped working, before receiving treatment with ramucirumab.

Ramucirumab is also used to treat other cancers, including advanced gastric cancer, gastro-esophageal junction adenocarcinoma, hepatocellular carcinoma, and metastatic colorectal cancer.^1,2

What is ramucirumab?

Ramucirumab is a targeted therapy that is classified as a monoclonal antibody. Antibodies are a normal part of the immune system that attach to antigens (such as germs) to mark them for destruction by the immune system. Monoclonal antibodies used in cancer treatment are created in a laboratory to attach to specific antigens on the surface of cancer cells. Ramucirumab targets human vascular endothelial growth factor receptor-2 (VEGFR-2), which then inhibits activation of vascular endothelial growth factor (VEGF), a protein that leads to the new development of blood vessels (a process called angiogenesis). By blocking VEGFR-2, ramucirumab may help shrink the cancer or slow the cancer’s progression.³

Receiving ramucirumab

Ramucirumab is given as an infusion in an IV (intravenous) line. Other medications may be given prior to the infusion to reduce the occurrence of a negative reaction to the infusion. The dosage is determined by several factors, including the patient’s weight, general health, the type of cancer, and ongoing response to treatment.³

Side effects of ramucirumab

Ramucirumab may cause side effects, and in some cases, these side effects can be severe. Any side effects should be reported to a health care professional. Side effects experienced in approximately 10-29 percent of patients receiving ramucirumab include high blood pressure, diarrhea, and headache. Rarely, ramucirumab can cause severe side effects, including an increase in the risk of bleeding, blood clots (arterial thromboembolic events), reactions to the infusion (shaking or stiffness of the body, back pain or spasms, chest pain or tightness, chills, flushing, difficulty breathing, wheezing, becoming blue due to lack of oxygen, and tingling or numbness of the skin), gastrointestinal perforation, impaired wound healing, clinical deterioration in patients with cirrhosis (scarring) of the liver, and reversible posterior leukoencephalopathy syndrome (a syndrome characterized by headache, confusion, seizures and vision changes). Patients who experience any of the following symptoms should seek immediate medical care: fever of 100.4°F (38°C) or greater, chills, a rash, vomiting (4-5 episodes within 24 hours), diarrhea (4-6 episodes within 24 hours), nausea that interferes with the ability to eat and is unrelieved by anti-nausea medication, signs of dehydration (tiredness, dry mouth, dark and decreased urine, or dizziness), decreased appetite, cough with or without mucus, or other signs of infection (including sore throat or pain with urination).^1,3,4

This is not an exhaustive list of all potential side effects of ramucirumab. Talk to your healthcare provider or pharmacist for further information.

Precautions

Patients receiving ramucirumab should talk to their doctor about any other medications (prescription and over-the-counter), herbal remedies, and any supplements they are taking, as well as any other health conditions. If you are pregnant, plan to become pregnant, or are breastfeeding or plan to breastfeed, talk with your doctor. Ramucirumab can cause harm to a developing fetus and should not be given to women who are pregnant. While receiving ramucirumab, females who can become pregnant should use contraceptives during treatment and for a period of time after completing treatment (patients should discuss appropriate birth control methods, and how long they need to use them, with their doctor). Females should not breastfeed during ramucirumab treatment and for a period of time following the final dose (patients should discuss breastfeeding considerations with their doctor).²