ramucirumab (Rx)

Action and Spectrum

Vascular endothelial growth factor receptor 2 (VEGFR2) is a type II trans-membrane tyrosine kinase receptor that is expressed on endothelial cells and is targeted by the human monoclonal antibody (IgG1) ramucirumab. 

By blocking the binding of its ligands (VEGF-A, VEGF-C, and VEGF-D), ramucirumab inhibits phosphorylation. 

Drug Interaction

Adverse Reaction

Adverse drug reactions:   

Frequency defined   

>10%:  

Hypertension  

peripheral edema    

Hypoalbuminemia  

Hypocalcemia  

hyponatremia  

Neutropenia  

thrombocytopenia  

Fatigue  

headache  

insomnia    

1% to 10%:  

Arterial thromboembolism  

Skin rash  

Intestinal obstruction  

vomiting  

Anemia  

Hepatic encephalopathy  

hepatorenal syndrome  

Infusion-related reaction  

Antibody development  

Back pain  

Pneumonia  

Fever  

Black Box Warning

None 

Contraindication / Caution

Contraindication: 

None  

Caution: 

Hemorrhage 

Hypertension 

Arterial Thromboembolic Events 

Gastrointestinal Perforation 

Pregnancy / Lactation

Pregnancy warnings:     

• US FDA pregnancy category: Not assigned  

Breastfeeding warnings:  

• The release of the drug into the human breastmilk is Unknown  

Pregnancy Categories:       

Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first trimester or the later trimester.       

Category B: No evidence shown of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women       

Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a result in humans must take care of potential risks in pregnant women       

Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits       

Category X: Drugs listed in this category outweigh risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.       

Category N: There is no data available for the drug under this category      

Pharmacology

Human endothelial cell migration and proliferation triggered by ligands are inhibited by ramucirumab, which blocks ligand-stimulated activation of VEGF2. 

VEGF-stimulated receptors as well as downstream ligand-induced migration, permeability, and proliferation of human endothelial cells. 

Adminstartion

Examine the diluted solution visually for discoloration and particle matter prior to ingestion. 

Do not deliver as an IV push or bolus; discard if particle matter or discolorations are detected. 

Use a protein-sparing 0.22-micron filter and administer the diluted fluid via an infusion pump through a different infusion line. 

If the initial infusion is tolerated, all subsequent infusions can be given over 30 minutes. Infuse the IV infusion over 60 minutes. 

After the infusion is complete, flush the line with sterile 0.9% NaCl. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ramucirumab 

Why do we use ramucirumab?  

Patients with advanced or metastatic gastric or gastro-esophageal junction adenocarcinoma may benefit from using ramucirumab alone or in conjunction with paclitaxel if their condition worsens following previous chemotherapy that contains fluoropyrimidines or platinum. 

It is recommended in conjunction with erlotinib as the initial treatment for metastatic non-small cell lung cancer that has exon 21 (L858R) point mutations or deletions in the epidermal growth factor exon 19. 

For individuals whose non-small cell lung cancer has spread after receiving platinum-based chemotherapy, it is also recommended in combination with docetaxel.