Ramucirumab (Cyramza, Eli Lilly) is a monoclonal antibody directed at theVEGFR-2 and is indicated for the treatment of gastric or gastroesophageal junction adenocarcinoma, metastatic NSCLC and metastatic CRC. The drug is administered as an IV infusion. Common adverse reactions, warnings and precautions, drug interactions and other contraindications for ramucirumab use are covered in this section.
Common adverse reactions
Warnings and precautions
Drug interactions and other contraindications
Ramucirumab common adverse reactions
The following adverse reactions were noted in clinical trials with ramucirumab monotherapy and in combination with other treatment regimens:
- single-agent ramucirumab (≥ 10% of patients): hypertension and diarrhea;
- ramucirumab in combination with paclitaxel (≥ 30% of patients): fatigue, neutropenia, diarrhea and epistaxis;
- ramucirumab in combination with docetaxel (≥ 30% of patients): neutropenia, fatigue, asthenia and stomatitis; and
- ramucirumab in combination with FOLFIRI (≥ 30% of patients): diarrhea, neutropenia, decreased appetite, epistaxis and stomatitis.
Ramucirumab warnings and precautions
The following adverse events have been reported with ramucirumab use:
- arterial thromboembolic events (serious and fatal arterial thromboembolic events were reported in clinical trials; these severe events should result in discontinuation of ramucirumab);
- hypertension (patients should be monitored and treated for hypertension);
- infusion reactions;
- impaired wound healing (patients should not receive ramucirumab before surgery);
- thyroid dysfunction; and
- proteinuria, including nephrotic syndrome (urine protein should be monitored, especially in patients receiving ramucirumab in combination with FOLFIRI).
Ramucirumab drug interactions and other contraindications
Women of childbearing age should be advised of the potential for fetal harm associated with ramucirumab.
Any severe or life-threatening adverse event may result in interruption or discontinuation of ramucirumab.