Cyramza (ramucirumab) for cancer treatment: Dosage, Side Effects & Pregnancy Safety

What is Cyramza (ramucirumab) and how is it used?

Cyramza is a prescription medication used for cancer treatment, which is given through intravenous (IV) infusion.

Cyramza is a human vascular endothelial growth factor receptor 2 antagonist that specifically binds VEGF Receptor 2 and blocks binding of VEGFR ligands, VEGF-A, VEGF-C, and VEGF-D. As a result, ramucirumab inhibits ligand-stimulated activation of VEGF Receptor 2, thereby inhibiting ligand-induced proliferation, and migration of human endothelial cells.

Cyramza is used to treat the following types of cancer:

Advanced or Metastatic Stomach or Gastroesophageal (GE) Junction Cancer
Metastatic Non-Small Cell Lung Cancer (NSCLC)
Metastatic Colorectal Cancer (CRC)
AFP-High Liver Cancer (Hepatocellular Carcinoma)

Cyramza is used in the following ways:

By itself or in combination with paclitaxel, a chemotherapy medication, to treat stomach cancer.
With the chemotherapy medication docetaxel to treat non-small cell lung cancer (NSCLC).
With a combination of chemotherapy medications called FOLFIRI (irinotecan, folinic acid, and fluorouracil) to treat colorectal cancer (CRC).
By itself to treat hepatocellular carcinoma (HCC), a type of liver cancer.

What are the most important side effects and other facts about Cyramza (ramucirumab)?

WARNING

HEMORRHAGE, GASTROINTESTINAL PERFORATION, AND IMPAIRED WOUND HEALING

Hemorrhage

Cyramza increased the risk of hemorrhage and gastrointestinal hemorrhage, including severe and sometimes fatal hemorrhagic events. Permanently discontinue Cyramza in patients who experience severe bleeding.

Gastrointestinal Perforation

Cyramza can increase the risk of gastrointestinal perforation, a potentially fatal event. Permanently discontinue Cyramza in patients who experience a gastrointestinal perforation.

Impaired Wound Healing

Impaired wound healing can occur with antibodies inhibiting the VEGF pathway. Discontinue Cyramza therapy in patients with impaired wound healing. Withhold Cyramza prior to surgery and discontinue Cyramza if a patient develops wound healing complications.

Other side effects of Cyramza (ramucirumab)

Cyramza can possibly cause serious side effects, including:

Hemorrhage
Gastrointestinal Perforations
Impaired Wound Healing
Arterial Thromboembolic Events
Hypertension
Infusion-Related Reactions
Worsening of Pre-existing Hepatic Impairment
Reversible Posterior Leukoencephalopathy SyndromeProteinuria Including Nephrotic Syndrome Thyroid Dysfunction

What is the dosage for Cyramza (ramucirumab)?

For intravenous infusion only. Do not administer as an intravenous push or bolus.

Gastric Cancer

The recommended dose of Cyramza either as a single agent or in combination with weekly paclitaxel is 8 mg/kg every 2 weeks.

Non-Small Cell Lung Cancer

Administer Cyramza at 10 mg/kg intravenously on day 1 of a 21-day cycle prior to docetaxel infusion.

Colorectal Cancer

Administer Cyramza at 8 mg/kg intravenously every 2 weeks, prior to FOLFIRI administration.

Cyramza (ramucirumab) contraindications, pregnancy safety and drug interactions

The safety and effectiveness of Cyramza in pediatric patients have not been established.
Based on its mechanism of action, Cyramza can cause fetal harm. Animal models link angiogenesis, VEGF and VEGF Receptor 2 (VEGFR2) to critical aspects of female reproduction, embryofetal development, and postnatal development. There are no available data on Cyramza use in pregnant women to inform any drug-associated risks
There is no information on the presence of ramucirumab in human milk, the effects on the breast-fed infant, or the effects on milk production.
Based on animal data, Cyramza may impair fertility.