Treatment Name: Ramucirumab (Cyramza®)
Ramucirumab (Cyramza®) is an Immunotherapy Regimen for Stomach Cancer
How does ramucirumab work?
Ramucirumab is designed to slow growth of cancer cells. Ramucirumab binds to receptors located on the surface of stomach 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. This is the first biological treatment as a single drug that increases survival time in stomach cancer patients.
Goals of therapy:
Ramucirumab is given to shrink tumors and reduce symptoms of stomach cancer. Ramucirumab is not commonly given with the goal of cure.
- Ramucirumab intravenous infusion over 60 minutes on Day 1
Estimated total infusion time for this treatment:
- Up to 90 minutes
- 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
Click here for common starting doses
Ramucirumab is repeated every 14 days. This is known as one Cycle. Each cycle is repeated until the drug no longer works or until unacceptable side effects occur.
Ramucirumab is usually given in an outpatient infusion center, allowing the person to go home afterward.
In clinical studies, the most commonly reported side effects with ramucirumab are shown here:
- Fatigue (36%)
- Abdominal pain (29%)
- Decreased appetite (24%)
- Vomiting (20%)
- High blood pressure (16%)
- Constipation (15%)
- Anemia [low red blood cells] (15%)
- Bleeding (13%)
- Trouble swallowing (11%)
- Shortness of breath (9%)
- Blood clots (6%)
On average, 11% of patients discontinue ramuciruimab due to unacceptable side effects
Side effect videos
Fatigue Nausea and VomitingConstipationAnemiaBleedingBlood ClotsPain
How often is monitoring needed?
Blood pressure and labs (blood tests) may be checked before each treatment or periodically during 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 and periodically during treatment. Imaging may include: computerized tomography (CT) scans or magnetic resonance image (MRI) scans
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue ramucirumab as planned, or delay or switch therapy
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
- Before each infusion, you will receive an antihistamine such as diphenhydramine (Benadryl®) to help prevent reactions to the infusion
- Blood pressure is checked before each infusion. If blood pressure is too high, the infusion could be cancelled or delayed until it is controlled
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for stomach cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering 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 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 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 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 Ramucirumab (Cyramza®)
Individual Drug Label Information
- 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)
- Low red blood cells and platelets
- 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
- Increased blood pressure
- Abdominal pain
- Nausea and vomiting
- Click on the ramucirumab (Cyramza) package insert below for reported side effects and possible drug interactions
Side Effect Videos
See DailyMed package insert.
Fatigue BleedingConstipationAnemiaBlood Clots
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Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014;383:31-39.
Created: December 6, 2015 Updated: September 22, 2018
What is Stomach Cancer?
A disease that starts in the cells lining the stomach, also known as gastric cancer. Stomach cancer tends to develop slowly over a long period of time, possibly over several years. The symptoms are not always severe, therefore it can go unnoticed in early stages. Early symptoms may include nausea, loss of appetite, heartburn, and abdominal pain. Later signs and symptoms can include vomiting, weight loss, difficulty swallowing, and blood in the stool. Stomach cancer may spread to other parts of the body, such as: lungs, liver, bones, and lymph nodes.
Stomach cancer is treated with surgery, chemotherapy, radiation therapy, or a combination of all these. The stage can vary at diagnosis and throughout treatment. Staging of stomach cancer uses Tumor, Node, Metastasis (TNM) system, as well as Stage Grouping 0, I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. 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 Starting Dose
Ramucirumab 8 mg/kg IV over 60 minutes
Cycle is once every 14 days
If you are interested in reading the clinical trials results, please click on references below:
Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014;383:31-39.
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.
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 status, 2) 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
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium
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.