Drug Action
Ramucirumab is a human monoclonal antibody that binds to the vascular endothelial growth factor receptor-2 (VEGFR-2), inhibiting VEGF-induced angiogenesis.
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Drug reference
Ramucirumab is a human monoclonal antibody that binds to the vascular endothelial growth factor receptor-2 (VEGFR-2), inhibiting VEGF-induced angiogenesis.
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Treatment of advanced gastric cancer or gastro- oesophageal junction adenocarcinoma, in combination with paclitaxel, in patients with disease progression after prior platinum and fluoropyrimidine chemotherapy Immune system and malignant disease ▶BY INTRAVENOUS INFUSION ▶Adult: 8 mg/kg on days 1 and 15 of a 28 day cycle, dose to be administered prior to paclitaxel infusion, consult product literature for dose adjustments due to side- effects and infusion-related reactions Treatment of advanced gastric cancer or gastro- oesophageal junction adenocarcinoma, as monotherapy, in patients with disease progression after prior platinum or fluoropyrimidine chemotherapy, and for whom treatment in combination with paclitaxel is not appropriate ▶BY INTRAVENOUS INFUSION ▶Adult: 8 mg/kg every 2 weeks, consult product literature for dose adjustments due to side-effects and infusion-related reactions Treatment of metastatic colorectal cancer, in combination with FOLFIRI (irinotecan, fluorouracil and folinic acid), in patients with disease progression on, or after, prior therapy with bevacizumab, oxaliplatin and a fluoropyrimidine ▶BY INTRAVENOUS INFUSION ▶Adult: 8 mg/kg every 2 weeks, dose to be administered prior to FOLFIRI administration, consult product literature for dose adjustments due to side-effects and infusion-related reactions Treatment of locally advanced or metastatic non-small cell lung cancer, in combination with docetaxel, in patients with disease progression after platinum-based chemotherapy ▶BY INTRAVENOUS INFUSION ▶Adult: 10 mg/kg on day 1 of a 21 day cycle, dose to be administered prior to docetaxel infusion, consult product literature for dose adjustments due to side- effects and infusion-related reactions
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Elective surgery—discontinue treatment for at least 4 weeks prior to surgery. hypertension—must be controlled before initiation. impaired wound healing— discontinue treatment until wound fully healed. pretreatment is recommended to minimise the development of adverse reactions (consult product literature). risk of bleeding
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For Cyramza ®, each 10 mL vial contains sodium 17 mg (equivalent to Na+ 0.74 mmol).
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NICE decisions ▶Ramucirumab for treating advanced gastric cancer or gastro- oesophageal junction adenocarcinoma previously treated with chemotherapy (January 2016) NICE TA378 Ramucirumab alone or in combination with paclitaxel is not recommended for the treatment of advanced gastric cancer or gastro-oesophageal junction adenocarcinoma previously treated with chemotherapy. Patients whose treatment was started before this guidance was published, should have the option to continue treatment until they and their clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta378 ▶Ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer (August 2016) NICE TA403 Ramucirumab, in combination with docetaxel, is not recommended for treating locally advanced or metastatic non-small-cell lung cancer in patients whose disease has progressed after platinum-based chemotherapy. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their clinicians consider it appropriate to stop. www.nice.org.uk/guidance/ta403
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→Appendix 1: monoclonal antibodies
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▶Common or very common Arterial thromboembolism. diarrhoea. electrolyte imbalance. epistaxis. gastrointestinal discomfort. gastrointestinal disorders. headache. hepatic coma. hepatic encephalopathy. hepatic pain. hypertension. hypoalbuminaemia. infusion related reaction. nephrotic syndrome. neutropenia. peripheral oedema. proteinuria. rash. thrombocytopenia ▶Frequency not known Aneurysm. artery dissection. cardiac arrest. cerebrovascular insufficiency. haemangioma. myocardial infarction. thrombotic microangiopathy SIDE-EFFECTS, FURTHER INFORMATION Infusion-related hypersensitivity reactions have been reported with ramucirumab, particularly during or following the first or second infusion; if the patient experiences a grade 1 or 2 infusion-related reaction, the manufacturer advises to reduce rate of infusion by 50% and give premedication for all subsequent infusions—consult product literature. Manufacturer advises to permanently discontinue treatment in the event of a grade 3 or 4 infusion-related reaction.
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Manufacturer advises effective contraception during treatment and for up to 3 months after treatment in women of childbearing potential.
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Manufacturer advises avoid unless potential benefit outweighs risk—no information available.
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Manufacturer advises discontinue breast-feeding during treatment and for at least 3 months after treatment—no information available.
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Manufacturer advises caution in severe cirrhosis, cirrhosis with hepatic encephalopathy, cirrhosis with clinically significant ascites, or hepatorenal syndrome (risk of progressive hepatic failure, no information available).
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Manufacturer advises monitor for signs of infusion-related hypersensitivity reactions; monitor blood pressure prior to each infusion; monitor for development or worsening of proteinuria during treatment—consult product literature; monitor blood counts and coagulation parameters in patients at risk of bleeding.
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For intravenous infusion (Cyramza ®), give intermittently in Sodium chloride 0.9%; dilute requisite dose with infusion fluid to final volume of 250 mL and invert gently to mix. Do not exceed a rate of 25 mg/minute, and give over approximately 60 minutes via an infusion pump using a separate infusion line with a protein sparing 0.22 micron filter.
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There can be variation in the licensing of different medicines containing the same drug. Solution for infusion ELECTROLYTES: May contain Sodium ▶Cyramza (Eli Lilly and Company Ltd) Ramucirumab 10 mg per 1 ml Cyramza 100mg/10ml concentrate for solution for infusion vials | 1 vial P £500.00 (Hospital only) Cyramza 500mg/50ml concentrate for solution for infusion vials | 1 vial P £2,500.00 (Hospital only) eiiii F 903
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8 mg/kg on days 1 and 15 of a 28 day cycle, dose
First-line fragment. Read the complete Indications and Dose section above.
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8 mg/kg every 2 weeks, consult product
First-line fragment. Read the complete Indications and Dose section above.
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8 mg/kg every 2 weeks, dose to be administered
First-line fragment. Read the complete Indications and Dose section above.
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10 mg/kg on day 1 of a 21 day cycle, dose to be
First-line fragment. Read the complete Indications and Dose section above.
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