ramucirumab

High Alert

Advanced gastric cancer or gastroesophageal junction adenocarcinoma following unsuccessful combination treatment that included a fluoropyrimidine or platinum compound (as monotherapy or in combination with paclitaxel).
First-line treatment of metastatic non–small cell lung cancer (NSCLC) in patients whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations (in combination with erlotinib).
Metastatic NSCLC with disease progression on or after platinum-based chemotherapy (in combination with docetaxel).
Metastatic colorectal cancer with disease progression on or after treatment with bevacizumab, oxaliplatin, and a fluoropyrimidine (in combination with irinotecan, folinic acid, and 5–fluorouracil [FOLFIRI]).
Hepatocellular carcinoma in patients with an alpha fetoprotein of ≥400 ng/mL who have been previously treated with sorafenib.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Child-Pugh Class B or C cirrhosis (use only if benefits outweigh risk of further deterioration);
Surgery (discontinue prior to surgery, reinstate when healing is complete);
Serious or non-healing wounds;
Hypertension (must be controlled prior to treatment);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, CARDIAC ARREST, MI

Derm: impaired wound healing

Endo: hypothyroidism

F and E: hyponatremia

GI: diarrhea, GI OBSTRUCTION/PERFORATION, worsened cirrhosis/hepatorenal syndrome

GU: ↓fertility (females), nephrotic syndrome, proteinuria

Hemat: bleeding, neutropenia

Neuro: encephalopathy, headache, POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES), STROKE

Misc: INFUSION-RELATED REACTIONS

Interactions ⬆ ⬇

Drug-drug:

↑risk of bleeding with anticoagulants, antiplatelet agents and NSAIDs.

Availability ⬆ ⬇

Solution for injection: 10 mg/mL

Route/Dosage ⬆ ⬇

Gastric Cancer or Hepatocellular Carcinoma

IV (Adults ): 8 mg/kg every 2 wk until disease progression or unacceptable toxicity.

Non–Small Cell Lung Cancer

IV (Adults ): First-line treatment in tumors with EGFR exon 19 deletions or exon 21 (L858R) substitution mutations: 10 mg/kg every 2 wk until disease progression or unacceptable toxicity; Disease progression on or after platinum-based therapy: 10 mg/kg on Day 1 of a 21-day cycle prior to docetaxel; continued until disease progression or unacceptable toxicity.

Colorectal Cancer

IV (Adults ): 8 mg/kg every 2 wk prior to FOLFIRI administration; continued until disease progression or unacceptable toxicity.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

A monoclonal antibody that binds to vascular endothelial growth factor receptor 2, antagonizing its effects, resulting in decreased angiogenesis.

Therapeutic effects:

Decreased growth and spread of gastric cancer, gastroesophageal junction adenocarcinoma, NSCLC, colorectal cancer, and hepatocellular carcinoma.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: vascular endothelial growth factor antagonists

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(improved survival)

ROUTE	ONSET	PEAK	DURATION
IV	within 1 mo	7–8 mo	24 mo

Patient/Family Teaching ⬆ ⬇

Explain purpose of ramucirumab to patient.
Advise patient to notify health care professional if bleeding or lightheadedness occur.
Instruct patient in self BP monitoring and advise patient to notify health care professional if signs and symptoms of hypertension (elevated BP, severe headache, lightheadedness, neurologic symptoms) or if severe diarrhea, vomiting, or severe abdominal pain occur.
Advise patient to notify health care professional of medication regimen prior to surgery; must be stopped for at least 4 wk before elective surgery and for at least 2 wk after major surgery until adequate wound healing occurs; may impair wound healing.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for at least 3 mo after last dose and avoid breastfeeding for 2 mo after last dose. Notify health care professional if pregnancy is suspected. Advise patient that ramucirumab may impair fertility in females.

section name header

Indications ⬇