Ramucirumab (Cyramza)
Antineoplastic Agent | Immunological Agent
Black Box Warning: Ramucirumab has a black box warning for increased risk of hemorrhage, including severe and sometimes fatal hemorrhagic events. It is also associated with an increased risk of gastrointestinal perforation, a serious and potentially fatal condition.
Ramucirumab is classified as a monoclonal antibody and angiogenesis inhibitor, used primarily for the treatment of specific types of cancer by inhibiting vascular endothelial growth factor receptor 2 (VEGFR2).
Indications and Use:
- Approved for use in gastric cancer or gastroesophageal junction adenocarcinoma as a single agent or in combination with paclitaxel after prior chemotherapy failure.
- Utilized in combination with docetaxel for the treatment of metastatic non-small cell lung cancer (NSCLC) after platinum-based chemotherapy failure.
- Also indicated in combination with FOLFIRI for metastatic colorectal cancer that has progressed on a first-line bevacizumab-containing regimen.
Mechanism of Action:
- Ramucirumab specifically binds to VEGFR2 and blocks the interaction with its ligands (VEGF-A, VEGF-C, and VEGF-D). This inhibition blocks the downstream signaling pathways that would otherwise lead to pathological angiogenesis and tumor growth.
Dosing Considerations:
- Depending on the specific cancer type and treatment regimen, ramucirumab is administered via intravenous infusion. Dosage adjustments may be necessary based on patient tolerance and side effect profile.
- Pre-medication with an antihistamine is recommended 30 minutes prior to infusion to reduce the risk of infusion-related reactions.
Monitoring and Side Effects:
- Monitor for signs of severe bleeding and hypertension, both of which are significant risks associated with ramucirumab. Blood pressure should be well controlled prior to starting therapy.
- Common side effects include hypertension, diarrhea, and headache. Less common but more severe side effects include infusion-related reactions and proteinuria.
Infusion Reactions:
- Infusion-related reactions are possible; symptoms may include rigors, chest pain, back pain, fever, and chills. The infusion rate may need adjustment, or the infusion may need to be discontinued based on the severity of the reaction.
Special Precautions:
- Use caution in patients with a history of arterial thromboembolic events as ramucirumab may increase the risk.
- Patients with recent gastrointestinal perforation or significant bleeding events should not be started on ramucirumab due to the heightened risk of similar events.
- There are risks associated with wound healing; ramucirumab therapy should be temporarily discontinued in patients undergoing surgical procedures.
Patient Education and Support:
- Educate patients about the potential side effects and the importance of promptly reporting symptoms of severe bleeding or sudden deterioration in their general health.
- Discuss potential impacts on wound healing and the need to report symptoms indicative of gastrointestinal perforation (severe abdominal pain, vomiting).
Drug Interactions and Contraindications:
- Avoid concomitant use of anticoagulants and other drugs that can significantly increase the risk of bleeding unless medically necessary.
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