Treatment Name: Docetaxel (Taxotere®) + Ramucirumab (Cyramza®)
How does docetaxel + ramucirumab work?
Docetaxel is designed to kill and slow the growth of lung cancer cells. Ramucirumab is an immunotherapy drug that binds to receptors located on the surface of lung cancer cells, called VEGFR-2, that signal the cell to make new blood vessels. Ramucirumab stops this signal making it difficult for the cancer to grow.
Goals of therapy:
Docetaxel + ramucirumab is a chemotherapy + immunotherapy treatment given to patients with metastatic lung cancer to help shrink tumors and decrease symptoms of lung cancer. While treatment may help some patients live longer, it is not commonly given with the goal of cure.
- Docetaxel intravenous (I.V.) infusion over 60 minutes on Day 1
- Ramucirumab I.V. infusion over 60 minutes on Day 1
- Dexamethasone 8 mg (two 4 mg tablets) by mouth twice daily the day before, the day of, and the day after docetaxel
Estimated total infusion time for docetaxel + ramucirumab treatment:
- Up to 3 hours for Day 1 of each Cycle
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Docetaxel + ramucirumab is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.
Docetaxel + ramucirumab is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common docetaxel + ramucirumab starting doses.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of docetaxel + ramucirumab are shown here:
- Fatigue (55%)
- Neutropenia [low white blood cells] (55%)
- Diarrhea (32%)
- Decreased appetite (29%)
- Bleeding (29%)
- Nausea (27%)
- Hair loss (26%)
- Mouth sores (23%)
- Tingling or numbness in fingers or toes (23%)
- Shortness of breath (22%)
- Cough (21%)
- Anemia [low red blood cells] (21%)
- Fever (17%)
- Swelling in arms or legs (16%)
- Constipation (16%)
- Neutropenic fever (16%)
- Thrombocytopenia [low platelets] (13%)
- Muscle pain (12%)
- Joint pain (11%)
- Back pain (11%)
- Stomach pain (11%)
- Weakness (11%)
- Trouble sleeping (11%)
- Headache (11%)
- High blood pressure (11%)
- Infusion reactions (4%)
- Blood clots (2-3%)
On average, 15% of patients discontinue treatment due to unacceptable side effects.
How often is docetaxel + ramucirumab monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), urine protein, thyroid function, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment then again if there are concerns for side effects or disease progression. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect this chemo-immunotherapy treatment?
Depending upon the results, your doctor may advise to continue docetaxel + ramucirumab as planned, reduce the dose of future treatments, delay the next treatment until the side effect goes away, or switch to an alternative therapy.
- Remember to take dexamethasone to help prevent excess fluid from staying in your body as a result of docetaxel treatment. If you forget, be sure to alert the doctor, pharmacist, or nurse at the infusion center. An intravenous dose of dexamethasone may be given if you forget any doses at home
- Before each ramucirumab infusion, you will receive an antihistamine such as diphenhydramine (Benadryl®) to help prevent reactions to the infusion
- Blood pressure is checked before each infusion of ramucirumab. If your blood pressure is too high, the infusion could be cancelled or delayed until it is controlled. You may need to be started on blood pressure medications or if you are already on blood pressure medications, they may need to be adjusted
- Tell your doctor if you plan on having any surgeries while on therapy with ramucirumab as it can delay wound healing from the surgery and possibly lead to complications
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for NSCLC. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering lung cancer study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Docetaxel (Taxotere®) + Ramucirumab (Cyramza®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Docetaxel (Taxotere®) + Ramucirumab (Cyramza®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Docetaxel (Taxotere®) + Ramucirumab (Cyramza®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Docetaxel (Taxotere®) + Ramucirumab (Cyramza®)