Ramucirumab

Ramucirumab is a prescription medication used for the treatment of Non-small cell lung cancer, gastric cancer, colorectal cancer, and hepatocellular cancer. 

• Ramucirumab  is available under the following different brand names: Cyramza

Adult dosage

IV solution

• 10mg/mL (10mL and 50mL vials)

Non-Small Cell Lung Cancer

Adult dosage

Combination therapy with docetaxel

• Ramucirumab 10 mg/kg IV on Day 1, PLUS
• Docetaxel 75 mg/m2 IV on Day 1
• Repeat cycle every 21 days
• Continue until disease progression or unacceptable toxicity
• Combination therapy with erlotinib
• Ramucirumab 10 mg/kg IV every 2 weeks, PLUS
• Erlotinib 150 mg orally every day
• Continue until disease progression or unacceptable toxicity

Gastric Cancer

Adult dosage

Combination with paclitaxel

• Days 1 and 15: Ramucirumab 8 mg/kg IV
• Days 1, 8, and 15: Paclitaxel 80 mg/m2
• Repeat cycle every 28 days
• Continue until disease progression or unacceptable toxicity

Colorectal Cancer

Adult dosage

• Ramucirumab 8 mg/kg IV every 2 weeks in combination with FOLFIRI
• Continue until disease progression or unacceptable toxicity

Hepatocellular Carcinoma

Adult dosage

• 8 mg/kg IV every 2 weeks

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Ramucirumab include:

• sores or white patches in or around the mouth,
• red or swollen gums,
• trouble swallowing or talking,
• dry mouth,
• bad breath,
• altered sense of taste,
• weakness,
• tiredness,
• diarrhea,
• loss of appetite,
• nosebleed,
• low white blood cell counts, and
• high blood pressure

Serious side effects of Ramucirumab include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• lightheadedness,
• chills,
• sweating,
• chest pain,
• chest tightness,
• back pain,
• numbness and tingling,
• severe stomach pain,
• bloody or tarry stools,
• coughing up blood,
• vomit that looks like coffee grounds,
• any wound that will not heal,
• headache,
• confusion,
• change in mental status,
• vision loss,
• seizure,
• severe or ongoing nausea,
• vomiting,
• diarrhea,
• rapid weight gain (especially in the face and midsection),
• fever,
• mouth sores,
• skin sores,
• sore throat,
• cough,
• puffy eyes,
• swelling in your ankles or feet,
• weight gain,
• urine that looks foamy,
• sudden numbness or weakness (especially on one side of the body),
• sudden severe headache,
• slurred speech,
• problems with vision or balance,
• chest pain or pressure,
• pain spreading to the jaw or shoulder,
• nausea, and
• sweating.

Rare side effects of Ramucirumab include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Ramucirumab has no noted severe interactions with any other drugs.
• Ramucirumab has no noted serious interactions with any other drugs.
• Ramucirumab has no noted moderate interactions with any other drugs.
• Ramucirumab has no noted minor interactions with any other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• None

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Ramucirumab?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Ramucirumab?”

Cautions

• Increased risk of hemorrhage and GI hemorrhage, including severe and sometimes fatal hemorrhagic events; permanently discontinue in patients who experience severe bleeding
• Serious, sometimes fatal, arterial thromboembolic events including myocardial infarction, cardiac arrest, cerebrovascular accident, and cerebral ischemia reported during clinical trials
• Increased incidence of severe hypertension reported; control hypertension before initiating treatment and monitor blood pressure every 2 weeks or more frequently as indicated; temporarily suspend therapy for severe hypertension
• Infusion-related reactions observed include rigors/tremors, back pain/spasms, chest pain and/or tightness, chills, flushing, dyspnea, wheezing, hypoxia, and paresthesia; in severe cases, symptoms included bronchospasm, supraventricular tachycardia, and hypotension
• Ramucirumab is an antiangiogenic therapy that can increase the risk of GI perforation and affect wound healing; withhold before surgery; permanently discontinue ramucirumab in patients who experience a gastrointestinal perforation
• Impaired wound healing can occur with antibodies inhibiting the VEGF or VEGFR pathway; VEGFR2 antagonist has the potential to adversely affect wound healing; not been studied in patients with serious or non-healing wounds
• Withhold for 28 days before elective surgery; do not administer for at least 2 weeks following a major surgical procedure and until adequate wound healing; safety of resumption after resolution of wound healing complications not established
• Clinical deterioration, manifested by new-onset or worsening encephalopathy, ascites, or hepatorenal syndrome, reported in patients with Child-Pugh B or C cirrhosis; use only if the benefits outweigh the risks
• Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is reported; confirmed diagnosis with magnetic resonance imaging; permanently discontinued in patients who develop PRES; symptoms may resolve or improve within days; some patients can experience ongoing neurologic sequelae or death
• Severe proteinuria, including nephrotic syndrome, is reported, monitor proteinuria by urine dipstick and/or urinary protein creatinine ratio; if the result of urine dipstick is 2+ or greater, perform a 24-hour urine collection for protein measurement; withhold drug for urine protein levels that are 2 or more grams over 24 hours; reinitiate drug at a reduced dose once urine protein level returns to less than 2 grams over 24 hours; permanently discontinue therapy for urine protein levels above 3 grams over 24 hours or in the setting of nephrotic syndrome
• May cause hypothyroidism; monitor thyroid function during treatment
• May cause fetal harm when administered to pregnant women

Pregnancy & Lactation

• Based on its mechanism of action, fetal harm may occur when administered to a pregnant woman
• There are no available data on use in pregnant women
• Pregnancy testing
  • Verify pregnancy status of females of reproductive potential before initiating therapy
• Contraception
  • Females: Advise females of reproductive potential to use effective contraception during treatment and for 3 months after the last dose
• Infertility
  • Advise females of reproductive potential that based on animal data, fertility may be impaired
• Lactation
  • Unknown if distributed in human breast milk; a decision should be made whether to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother
  • Human IgG is excreted in human milk, but published data suggest that breast milk antibodies do not enter the neonatal and infant circulation in substantial amounts