Ramucirumab (Cyramza™)

OncoLink Team
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 29, 2014

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Classification: Monoclonal Antibody
Pronounced: RA myoo SIR yoo mab

About Ramucirumab

Ramucirumab is a monoclonal antibody that inhibits the activity of vascular endothelial growth factor (VEGF). VEGF is responsible for angiogenesis, or the development of new blood vessels by and for the tumor (or any tissue), so blocking VEGF’s activity prevents the growth of new blood vessels, essentially cutting off the tumor's source of nutrients.

How to Take Ramucirumab

Ramucirumab is given by intravenous (IV, into a vein) infusion by a trained nurse. The actual dosage depends on the patient’s weight.

There is a risk of having a reaction during or after the infusion and patients are given diphenhydramine prior to each infusion to reduce this risk. Signs of a reaction can include: severe chills, back pain, chest pain or tightness, flushing, difficulty breathing and lightheadedness. If you experience any of these symptoms, notify your nurse right away. Patients who have had a reaction to a prior infusion may be given additional premedication.

Possible Side Effects of Ramucirumab

Ramucirumab has the potential to cause several serious side effects, of which you should be aware. There are things you can do to manage the more common side effects of ramucirumab. Talk to your doctor or nurse about these recommendations, as they can help you decide what will work best for you.

Hemorrhage (Bleeding)

Serious bleeding has also occurred in patients treated with this medication. People who have a history of serious bleeding should not take this medication. If you take aspirin, non-steroidal anti-inflammatory medications (i.e. Motrin, ibuprofen, naproxen) or other medication that interferes with blood clotting, let your healthcare provider know. Signs of bleeding can include: blood in the stool or dark, tarry stools, coughing up or vomiting blood or vomit that looks like coffee grounds. While some bleeding, such as a nosebleed, may not seem like much of a concern, you should notify your healthcare team right away if you develop bleeding of any sort.

Hypertension (High Blood Pressure)

Patients receiving ramucirumab can develop high blood pressure. Your blood pressure should be monitored at least every 2 weeks. If severe hypertension develops, ramucirumab should be discontinued until your blood pressure is controlled with medication. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm has been affected.

Additional Rare, But Serious, Side Effects

In clinical trials, some patients developed proteinuria, which is the presence of protein in the urine and can be a sign of kidney damage. Your oncology team will periodically check your urine for protein.

Ramucirumab can result in a serious, sometimes fatal, problem called gastrointestinal perforation, which is the development of a hole in the stomach or small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.

Ramucirumab can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that ramucirumab be discontinued prior to any surgery. In addition, any surgical incision should be fully healed prior to starting or restarting ramucirumab. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.

A neurologic complication, called reversible posterior leukoencephalopathy syndrome, has been reported. If you experience headache, seizure, confusion, blindness or other visual changes, inform your healthcare provider right away.

Emergent Side Effects

In studies, patients experienced blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes.


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