- Class: Monoclonal antibody – VEGFR-2 antagonist.
- Type: Fully human IgG1 mAb.
Mechanism of Action (MOA)
- Binds to VEGFR-2 → blocks binding of VEGF ligands (VEGF-A, VEGF-C, VEGF-D).
- Inhibits angiogenesis, reducing tumor blood supply → tumor growth suppression.
- Does not bind VEGFR-1 → more selective angiogenesis inhibition.
Clinical Uses
- Gastric or gastroesophageal junction adenocarcinoma – advanced or metastatic, typically second-line therapy (with paclitaxel).
- Metastatic non-small cell lung cancer (NSCLC) – second-line in combination with docetaxel.
- Hepatocellular carcinoma (HCC) – second-line after sorafenib.
- Investigational/less common: colorectal cancer, breast cancer (trials ongoing).
Dosing (Adults)
- Gastric/GEJ cancer: 8 mg/kg IV every 2 weeks (with paclitaxel).
- NSCLC: 10 mg/kg IV every 3 weeks (with docetaxel).
- Infuse over 60 minutes for first infusion, may shorten for subsequent doses if tolerated.
- No routine premedication required.
Toxicities
- Hypertension – common; monitor BP regularly.
- Proteinuria – monitor urinalysis/urine protein.
- Bleeding/hemorrhage – epistaxis, GI bleeding.
- GI perforation – rare but serious.
- Impaired wound healing – avoid surgery 28 days after or before therapy.
- Fatigue, diarrhea, neutropenia (from combination chemotherapy).
Monitoring
- Blood pressure (baseline and before each dose).
- Urinalysis / urine protein (baseline and periodically).
- CBC and renal function when used with chemotherapy.
- Signs of bleeding or thromboembolic events.
- Electrolytes and hepatic function as clinically indicated.
Summary
Ramucirumab (Cyramza®) is a VEGFR-2-targeted antiangiogenic monoclonal antibody used mainly in second-line gastric, NSCLC, and HCC. Key concerns are hypertension, proteinuria, bleeding, and impaired wound healing. Monitor BP, urine protein, and combination chemotherapy toxicities.