Ramucirumab (Cyramza)

At a glance

Ramucirumab is a targeted antibody given through a drip into a vein. It can be used on its own or with another cancer medicine, depending on the type of cancer and previous treatment. It can raise blood pressure, cause protein to leak into the urine and affect bleeding and wound healing. Tell your team about planned surgery or dental procedures before treatment.

How it is given. You receive ramucirumab as a drip into a vein.

How it works

Cancer can use signals to help grow new blood vessels. Ramucirumab blocks one of the receptors that receives these signals, called vascular endothelial growth factor receptor 2 (VEGFR2). This can slow the growth of blood vessels that feed the cancer. The same pathway helps normal tissues heal, which is why the team asks about recent surgery and wounds.

Is this treatment suitable for me?

Ramucirumab may be used for some advanced stomach cancers or cancers where the food pipe joins the stomach, often with paclitaxel after earlier chemotherapy. Other uses depend on the country, test results and medicines already tried. Examples include certain lung cancers with erlotinib or docetaxel, colorectal cancer with a chemotherapy combination called FOLFIRI, and a type of liver cancer with a high level of a blood marker called alpha-fetoprotein (AFP). Ask which indication applies where you are being treated and which other medicines are part of your plan.

Before treatment starts

Tell your team if you have high blood pressure, liver disease, recent bleeding, a previous heart attack or stroke, or any wound that is still healing. Bring a full list of medicines, including aspirin, blood thinners, painkillers and supplements.

Tell your team about any planned operation or tooth extraction before booking it. The US prescribing information advises pausing ramucirumab 28 days before elective surgery. After major surgery, it advises waiting at least two weeks and until the wound has healed adequately. Your oncology and surgical teams should agree the dates with you.

How treatment is given

A nurse gives ramucirumab through a drip. The interval depends on which cancer is being treated and whether other drugs are given on the same day. You may receive an antihistamine before treatment to reduce the risk of a reaction. Ask what to take at home and how long to allow at the unit.

Tell the nurse straight away if you develop chills, flushing, back pain, chest tightness, wheezing or dizziness during the drip. Staff can assess the reaction and slow or stop the infusion if needed.

Monitoring your treatment

Your team checks blood pressure before treatment and regularly during the course. You may be asked to record home readings. Ask when to measure and which readings mean you should call.

A urine test checks for protein leaking through the kidneys. If a screening test shows increased protein, your team may ask for a longer urine collection. Blood tests can include kidney, liver and thyroid checks. Scans and your symptoms help the team review whether treatment is helping.

Side effects

Effects to look out for

• High blood pressure. You may feel well even when a reading is high. Bring your record and follow the team’s instructions for treatment and repeat readings.
• Protein in the urine. You may not notice it. Tell the team if you see persistent foam in urine or develop new puffiness or swelling.
• Nosebleeds, tiredness or diarrhoea. These can occur, and the pattern varies with the other medicines in your plan. Report bleeding and tell the team if bowel changes make it difficult to drink.
• Low blood counts. Your chemotherapy combination may lower infection-fighting cells or platelets. Ask which symptoms to report between visits.

Important side effects

Ramucirumab can sometimes cause serious bleeding, a tear in the bowel or a clot in an artery. It can also delay wound healing. Tell your team about bleeding, pain that is new or worsening, or a wound that is reopening or failing to heal.

A rare brain condition can cause a severe headache, vision changes, a seizure or confusion. People with serious liver disease can also develop worsening liver-related problems. Seek advice for new abdominal swelling, unusual sleepiness or confusion.

Practical advice for this treatment

Plan procedures with both teams

Give the oncology team the date of any planned surgery or dental extraction. Ramucirumab can slow wound healing. The oncologist and surgeon should agree when to pause it and when a wound has healed enough to restart. Tell them about any previous wound complication.

Keep a record of blood pressure and urine tests

Ask whether home blood pressure readings are useful and which readings or headaches you should report. The team may test for protein in urine and may need to repeat an unexpected result. Report new swelling or a marked change in how much urine you pass.

Check the advice for the other medicines

Side effects may also come from the partner medicine in your regimen. For example, paclitaxel can cause tingling, and the combination that includes irinotecan can cause diarrhoea. Ask which symptoms need a different response because you are having more than one medicine.

Other medicines and vaccinations

Ask the oncology team to check any new prescription, over-the-counter product or supplement. Check before taking aspirin or anti-inflammatory painkillers and ask how to manage blood thinners already prescribed. Let your team decide whether to change them. Ask about vaccines in the context of your full treatment plan.

Everyday life

Keep a list of your medicines and the date of your last drip. Bring your blood pressure record if asked to keep one. If you are going to see a dentist or a surgeon, tell them you are having ramucirumab and give them the oncology team’s contact details.

Fertility, pregnancy and breastfeeding

Ramucirumab can harm a developing baby. The US prescribing information advises effective contraception for people who could become pregnant during treatment and for three months after the last dose. It advises avoiding breastfeeding during treatment and for two months afterwards. Ask about fertility preservation before starting if this matters to you. Confirm the dates for your full combination and the product you receive.

After treatment

Ask when to repeat any blood pressure, urine or blood checks and when to follow up on a wound. Tell other clinicians the date of your last dose before any procedure.

Frequently asked questions