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Ramucirumab

Class
VEGF inhibitors
Subclass
Anti-VEGF receptor 2 monoclonal antibodies
Generic name
Ramucirumab
Brand names
Cyramza®
Common formulations
Solution
Dosage and administration
Adults patients
HCC
•
8 mg/kg IV q2 weeks until disease progression or unacceptable toxicity
Metastatic CRC
•
8 mg/kg IV q2 weeks until disease progression or unacceptable toxicity
Non-small cell lung cancer in patients with ALK rearrangement • Metastatic
•
10 mg/kg IV q2 weeks until disease progression or unacceptable toxicity
Indications for use
Labeled indications
Adults
•
Treatment of gastric cancer
•
Treatment of HCC
•
Treatment of metastatic CRC
•
Treatment of non-small cell lung cancer in patients with ALK rearrangement (metastatic)
Safety risks
Boxed warnings
Myocardial infarction
•
Use extreme caution with a history of arterial thromboembolic diseases.
Contraindications
A known hypersensitivity to Ramucirumab
Gastric cancer, receiving concomitant chronic NSAID therapy, anti-platelet therapy (other than once-daily aspirin), or therapeutic anticoagulant therapy
Warnings and precautions
Hepatic encephalopathy
•
Use caution with mild to moderate hepatic disease.
Hypertension
•
Use caution with underlying cardiac disease, or have risk factors associated with hypertension.
Hypothyroidism
•
Use caution with a history of pre-existing thyroid disease.
Nephrotic syndrome
•
Use caution with renal impairment.
Posterior reversible encephalopathy syndrome
•
Use caution with risk factors for developing Posterior Reversible Encephalopathy Syndrome, including; seizures, headache, nausea/vomiting, blindness, and altered mental status.
Specific populations
Renal impairment
eGFR 29-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for proteinuria.
eGFR 15-29 mL/min/1.73 m²
•
Use with caution. Monitor for proteinuria.
eGFR < 15 mL/min/1.73 m²
•
Use with caution. Monitor for proteinuria.
Renal replacement therapy
Continuous renal replacement
•
Use with caution. Dose as in eGFR 15-29 mL/min/1.73 m². Monitor for proteinuria.
Intermittent hemodialysis
•
Use with caution. Dose as in eGFR < 15 mL/min/1.73 m². Monitor for proteinuria.
Peritoneal dialysis
•
Use with caution. Dose as in eGFR < 15 mL/min/1.73 m². Monitor for proteinuria.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use with caution.
Child-Pugh C (severe)
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Avoid use. Evidence of fetal harm in humans. Based on its mechanism of action, this drug may cause fetal harm.
•
If a patient becomes pregnant while taking this drug, she should be apprised of the potential hazard to a fetus.
•
Female patients should be advised to avoid getting pregnant while receiving this drug and for at least 3 months after the last dose.
•
Females of reproductive potential should be advised that this drug may impair fertility.
Breastfeeding
Use with caution during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Alopecia, ascites, ↓ platelet count, febrile neutropenia, gastrointestinal bleeding, hypertension, hypoalbuminemia, ↑ TSH, ↑ urine protein, infections, palmar-plantar erythrodysesthesia, peripheral edema, abdominal pain, asthenia, bleeding, diarrhea, fatigue, headache, insomnia, loss of appetite, nausea, nosebleed, stomatitis
Common 1-10%
•
Anemia, arterial thromboembolism, bowel obstruction, ↓ blood neutrophil count, ↓ serum sodium, gastrointestinal perforation, hepatic encephalopathy, hepatorenal syndrome, hypothyroidism, infusion-related reactions, back pain, fever, gum bleeding, skin rash, vomiting, sepsis
Uncommon < 1%
•
Nephrotic syndrome
Rare < 0.1%
•
Posterior reversible encephalopathy syndrome
Unknown frequency
•
Aortic rupture, arterial aneurysm, arterial dissection, heart failure, hemangioma, pneumonia, pulmonary hemorrhage, thrombotic microangiopathy
Interactions
Drug(s)
Check Interactions
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