ramucirumab at a glance
Medicine class
VEGFR-2-blocking monoclonal antibody and anti-angiogenic treatment
How it is given
Intravenous infusion prepared and administered by a specialist cancer service
Key monitoring
Blood pressure, urine protein, blood tests, bleeding risk and infusion reactions
What is ramucirumab used for?
UK-licensed uses in adults include:
Advanced gastric cancer or gastro-oesophageal junction adenocarcinoma that has progressed after specified previous chemotherapy, usually with paclitaxel; it may be used alone when paclitaxel is unsuitable.
Metastatic colorectal cancer that has progressed on or after specified previous treatment, combined with FOLFIRI chemotherapy.
Metastatic non-small cell lung cancer with an activating EGFR mutation, combined with erlotinib as first-line treatment.
Locally advanced or metastatic non-small cell lung cancer that has progressed after platinum-based chemotherapy, combined with docetaxel.
Advanced or unresectable hepatocellular carcinoma after sorafenib in patients whose serum alpha-fetoprotein meets the licensed threshold, used alone.
How does ramucirumab work?
Ramucirumab binds to vascular endothelial growth factor receptor 2 (VEGFR-2). This prevents VEGF signals from activating the receptor, reducing the formation and maintenance of blood vessels that can support tumour growth.
ramucirumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 10 mg/mL
How to take ramucirumab
A hospital pharmacist or clinician dilutes the concentrate, and a doctor or nurse gives it through a drip. The team monitors for infusion reactions; preventive medicines may be given beforehand. Ramucirumab is not taken by mouth or given as a rapid intravenous injection.
Tell staff immediately about chest tightness, flushing, chills, back pain, wheezing, breathlessness, tingling or faintness during the infusion.
Tell the oncology team about planned surgery, recent surgery or a wound that is not healing.
Read the information for every other anticancer treatment given with ramucirumab.
ramucirumab side effects
Common or expected effects
- Tiredness or weakness
- Diarrhoea or abdominal pain
- High blood pressure
- Headache
- Nosebleeds
- Sore or inflamed mouth
- Swelling caused by fluid retention
- Protein in the urine
- Low blood-cell counts and increased infection risk
- Hair loss when used with some combination treatments
Get urgent medical advice
- Severe bleeding, including gastrointestinal or pulmonary bleeding
- A hole in the stomach or bowel
- Arterial blood clot causing a heart attack or stroke
- Severe infusion-related or allergic reaction
- Severe or uncontrolled hypertension
- Seizure, blindness or altered consciousness suggesting posterior reversible encephalopathy syndrome
- Severe infection or sepsis
- Heart failure symptoms such as worsening breathlessness and swelling
- Aneurysm or artery dissection
- Poor wound healing or an abnormal internal connection called a fistula
ramucirumab in pregnancy
Ramucirumab is not recommended during pregnancy because blocking blood-vessel development may harm the pregnancy or fetus. Effective contraception is required during treatment and for the specified period afterwards; anyone who becomes pregnant or is planning pregnancy should contact the oncology team promptly. Possible effects on fertility should be discussed before treatment where relevant.
ramucirumab while breastfeeding
It is unknown whether ramucirumab enters human milk, and risk to a breastfed child cannot be excluded. Breastfeeding should stop during treatment and should not restart until the oncology team confirms that the required post-treatment period has passed.
ramucirumab interactions
Provide the oncology team with a complete list of prescribed, over-the-counter and complementary products.
Anticoagulants
Medicines that reduce blood clotting may add to ramucirumab's bleeding risk, requiring individual assessment and monitoring.
Antiplatelet medicines and non-steroidal anti-inflammatory drugs
These may increase bleeding concerns, particularly in people with lung cancer; check before using them.
Paclitaxel, irinotecan, docetaxel and erlotinib
Studies did not identify clinically relevant pharmacokinetic interactions with ramucirumab, although each combination has its own toxicity and monitoring requirements.
Common questions about ramucirumab
Answers are fully visible for fast scanning and source review.
Is ramucirumab chemotherapy?
No. Ramucirumab is a targeted monoclonal antibody, although it is commonly given alongside chemotherapy or erlotinib.
How is ramucirumab given?
It is diluted and administered into a vein by a specialist cancer service. It is not a tablet or rapid intravenous injection.
What tests are needed with ramucirumab?
Monitoring commonly includes blood pressure, urine protein and blood tests. Additional cancer-specific tests may include EGFR mutation or alpha-fetoprotein assessment.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.