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Cyramza (ramucirumab)

Cyramza® is a targeted therapy that is used to treat metastatic non-small cell lung cancers (NSCLC).
It is used in combination with the chemotherapy drug docetaxel in patients with metastatic NSCLC whose disease has progressed on or after platinum based chemotherapy. Patients having EGFR or ALK tumor abnormalities should have progression with approved therapy for these abnormal genes before treatment with ramucirumab. Ramucirumab is also used to treat other cancers, including advanced gastric cancer, gastro-esophageal junction adenocarcinoma, and metastatic colorectal cancer.1,2

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 other components in the immune system. Monoclonal antibodies 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 every three weeks for NSCLC patients. 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 10-29% of patients taking 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) (This is not a complete list of side effects).1,3,4

Precautions

Patients receiving ramucirumab should talk to their doctor about other medications, herbal remedies, and any supplements they are taking, as well as any other health conditions. Patients should talk to their doctor before receiving immunizations or vaccinations while taking ramucirumab to make sure they are appropriate. Patients who are pregnant or may become pregnant during treatment should discuss their condition with their doctor prior to starting ramucirumab, as it may be hazardous to the fetus. It is not recommended for men or women to conceive a child while taking ramucirumab, and patients are advised to use barrier methods of contraception (i.e. condoms). It is not known whether ramucirumab passes into breast milk, and patients should not breastfeed while taking ramucirumab.2

Written by: Emily Downward | Last reviewed: April 2019.
  1. Cyramza product website, Eli Lilly and Company. Accessed online on 9/28/16 at http://www.cyramza.com/.
  2. MedlinePlus, U.S. National Library of Medicine. Accessed online on 9/28/16 at https://medlineplus.gov/druginfo/meds/a614026.html
  3. Chemocare. Accessed online on 9/28/16 at http://chemocare.com/chemotherapy/drug-info/cyramza.aspx.
  4. Medscape. Accessed online on 9/29/16 at http://www.medscape.com/viewarticle/522192?pa=k%2F0OsoEDOcjofUM659wmEs%2BOFr7YhBN0NpObj9mVnSm8t5fNf%2FfCac4Ain2HiHdnJyGvMX%2Fu%2BWdIXoARf%2FT0zw%3D%3D.