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Treatment Name: Docetaxel (Taxotere®) + Ramucirumab (Cyramza®)

Docetaxel (Taxotere®) + Ramucirumab (Cyramza®) is a Treatment Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

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.

Schedule

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  • 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.

Side Effects

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.

Side effect videos Side Effect Videos
Fatigue Fatigue DiarrheaDiarrheaBleedingBleedingNausea and VomitingNausea and VomitingHair LossHair LossAnemiaAnemiaConstipationConstipationNeutropenic FeverNeutropenic FeverPainPainBlood ClotsBlood Clots

Monitoring

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.

ChemoExperts Tips

  • 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:

  • Docetaxel
  • Ramucirumab

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.

Emotional Wellness

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®)

Individual Drug Label Information

Docetaxel (Taxotere®)

  • Docetaxel iIs an intravenous (I.V.) infusion
  • There is an increased  chance of death in patients treated with this drug who have poor liver function, are treated with higher doses, in patients with non-small cell lung cancer and a history of using other “platinum-based chemotherapy” drugs
  • Docetaxel should not be given when a certain blood cell count, neutrophils, get below 1500 cells.  The physician may hold therapy or reduce the dose and continue treatment if this occurs
  • Dosage adjustment may be required for poor liver function
  • Severe fluid retention may occur, especially when combined with prednisone
  • Docetaxel may interact with strong CYP3A4 inhibitors (e.g. ketoconazole) and proteosome inhibitors (e.g. Ritonavir) may increase concentrations of docetaxel and lead to increased toxicity or side effects. More frequent laboratory monitoring and docetaxel dosage adjustment may be needed
  • Severe hypersensitivity may occur, although rare
General Docetael (Taxotere) Side Effects
  • Hair loss
  • Low red blood cell count and fatigue
  • Nausea/vomiting
  • Diarrhea
  • Low white blood cell count and associated infections. Blood cell counts, including neutrophils (ANC) should be checked regularly
  • Nail changes on fingers and toes
  • Loss of sensation
  • Swelling in the extremities
  • Mouth sores 
  • Changes in taste
  • Loss of appetite
  • Shortness of breath
  • Muscle pain
  • Tearing of eyes or vision problems
  • Heart problems
  • Click on the docetaxel (Taxotere) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Ramucirumab (Cyramza®)

  • Ramucirumab iIs an intravenous (I.V.) infusion
  • Has a risk for rupture of the stomach or intestines.  Contact your doctor or go to the emergency room if you experience severe abdominal pain that is worse when moving or if you vomit up blood
  • Can cause severe bleeding. Contact you doctor or go to the emergency room if you have any signs or symptoms of bleeding. Avoid medications such as aspirin, ibuprofen, and naproxen
  • Known to impair or slow wound healing. Ramucirumab will need to be held before and after any planned surgery you may have
  • May increase blood pressure in a small number of patients
  • Dosage adjustments may be required when there is high protein in the urine
  • If infusion-related reactions occur, additional pre-medications are given. This may include acetaminophen (Tylenol®) or dexamethasone (or equivalent)
General Ramucirumab (Cyramza) Side Effects
  • Low red blood cells and platelets
  • Bleeding
  • Blood clots; a medication to lower the risk of developing blood clots may be necessary
  • Infusion reactions such as fever, chills, shaking or sweating
  • Damage to kidneys
  • Decreased thyroid function
  • Diarrhea
  • Increased blood pressure
  • Headache
  • Fatigue
  • Abdominal pain
  • Nausea and vomiting
  • Constipation
  • Click on the ramucirumab (Cyramza) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Fatigue Fatigue BleedingBleedingConstipationConstipationAnemiaAnemiaBlood ClotsBlood Clots

See DailyMed package insert.

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References

1) Garon EB, Ciuleanu TE, Arrieta O, et al. Ramucirumab plus docetaxel versus placebo plus docetaxel for second-line treatment of stage IV non-small-cell lung cancer after disease progression on platinum-based therapy (REVEL): a multicentre, double-blind, randomised phase 3 trial. Lancet. 2014;384:665-673.

Created: October 9, 2019 Updated: October 9, 2019

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Docetaxel (Taxotere®) + Ramucirumab (Cyramza®) starting doses

  • Docetaxel 75 mg/m2 intravenous (I.V.) infusion over 60 minutes on Day 1
  • Ramucirumab 10 mg/kg 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

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium