Ramucirumab

What is Ramucirumab

Ramucirumab is a fully human monoclonal antibody that binds with high affinity to the extracellular domain of vascular endothelial growth factor receptor 2 (VEGFR2; kinase insert domain-containing receptor; KDR), preventing the binding of VEGF-A, VEGF-C, and VEGF-D.

The mechanism of binding to VEGFR2 rather than VEGF may lead to less resistance since endothelial cells are genetically stable.

Ramucirumab is indicated as monotherapy for the treatment of advanced or metastatic gastric or gastro-esophageal junction (GEJ) cancer as well as previously treated hepatocellular cancer in patients with an alpha-fetoprotein of 400 ng/mL or more.

It is also indicated in combination with paclitaxel for advanced or metastatic gastric/GEJ cancer, in combination with docetaxel for metastatic non-small cell lung cancer (NSCLC) after progression on platinum-based therapy, and in combination with FOLFIRI for metastatic colorectal cancer in patients previously treated with bevacizumab, oxaliplatin, and a fluoropyrimidine. 

Brand Name

Cyramza

Indications

  • colorectal cancer
  • gastric cancer
  • hepatocellular cancer
  • non-small cell lung cancer (NSCLC)

For the treatment of gastric cancer or gastro-esophageal junction adenocarcinoma

for the treatment of advanced or metastatic gastric or gastro-esophageal junction adenocarcinoma with disease progression on or after fluoropyrimidine- or platinum-containing chemotherapy, as monotherapy

Side Effects

  1. abdominal pain
  2. abdominal pain
  3. anorexia
  4. anorexia
  5. antibody formation
  6. ascites
  7. ascites
  8. asthenia
  9. asthenia
  10. back pain
  11. back pain
  12. bleeding
  13. bleeding
  14. bronchospasm
  15. cardiac arrest
  16. chest pain (unspecified)
  17. chills
  18. diarrhea
  19. diarrhea
  20. dysphonia
  21. dyspnea
  22. encephalopathy
  23. epistaxis
  24. epistaxis
  25. fatigue
  26. fatigue
  27. fever
  28. flushing
  29. GI bleeding
  30. GI bleeding
  31. GI obstruction
  32. GI perforation
  33. headache
  34. hepatic encephalopathy
  35. hepatic encephalopathy
  36. hypertension
  37. hypertension
  38. hypoalbuminemia
  39. hypoalbuminemia
  40. hypocalcemia
  41. hypocalcemia
  42. hyponatremia
  43. hyponatremia
  44. hypotension
  45. hypothyroidism
  46. hypoxia
  47. impaired wound healing
  48. infection
  49. infusion-related reactions
  50. infusion-related reactions
  51. insomnia
  52. lacrimation
  53. lacrimation
  54. leukoencephalopathy
  55. myocardial infarction
  56. nausea
  57. nephrotic syndrome
  58. neutropenia
  59. neutropenia
  60. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  61. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  62. paresthesias
  63. peripheral edema
  64. peripheral edema
  65. proteinuria
  66. proteinuria
  67. rash
  68. stomatitis
  69. stomatitis
  70. stroke
  71. supraventricular tachycardia (SVT)
  72. thrombocytopenia
  73. thrombocytopenia
  74. thrombosis
  75. thrombotic microangiopathy
  76. tremor
  77. vomiting
  78. wheezing

Monitoring Parameters

  • blood pressure
  • pregnancy testing
  • thyroid function tests (TFTs)
  • urinalysis

Contraindications

  • anticoagulant therapy
  • biliary cirrhosis
  • bleeding
  • breast-feeding
  • cardiac arrest
  • contraception requirements
  • encephalopathy
  • GI bleeding
  • GI perforation
  • hepatic disease
  • human anti-human antibody (HAHA)
  • hypertension
  • hypothyroidism
  • impaired wound healing
  • infertility
  • infusion-related reactions
  • myocardial infarction
  • pregnancy
  • pregnancy testing
  • proteinuria
  • renal disease
  • reproductive risk
  • stroke
  • surgery
  • thyroid disease

Interactions

  • Clozapine
  • Palifermin
  • Penicillamine
  • Tuberculin Purified Protein Derivative, PPD
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