Classification: Monoclonal Antibody
About Ramucirumab (Cyramza®)
Ramucirumab is a monoclonal antibody that inhibits the activity of vascular endothelial growth factor (VEGF). VEGF is responsible for angiogenesis, or the development of new blood vessels by and for the tumor (or any tissue), so blocking VEGF’s activity prevents the growth of new blood vessels, essentially cutting off the tumor's source of nutrients.
How to Take Ramucirumab
Ramucirumab is given by intravenous (IV, into a vein) infusion by a trained nurse. The actual dosage depends on the patient’s weight. It is usually infused over 60 minutes. It may be given in combination with other chemotherapy medications.
Possible Side Effects of Ramucirumab
Ramucirumab has the potential to cause several serious side effects, of which you should be aware. There are things you can do to manage the more common side effects of ramucirumab. Talk to your doctor or nurse about these recommendations, as they can help you decide what will work best for you.
There is a risk of having a reaction during or after the infusion and patients are given diphenhydramine prior to each infusion to reduce this risk. Signs of a reaction can include: severe chills, back pain, chest pain or tightness, flushing, difficulty breathing and lightheadedness. If you experience any of these symptoms, notify your nurse right away. Patients who have had a reaction to a prior infusion may be given additional premedication.
Serious bleeding has also occurred in patients treated with this medication. People who have a history of serious bleeding should not take this medication. If you take aspirin, non-steroidal anti-inflammatory medications (i.e. Motrin, ibuprofen, naproxen) or other medication that interferes with blood clotting, let your healthcare provider know. Signs of bleeding can include: blood in the stool or dark, tarry stools, coughing up or vomiting blood or vomit that looks like coffee grounds. While some bleeding, such as a nosebleed, may not seem like much of a concern, you should notify your healthcare team right away if you develop bleeding of any sort.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
High Blood Pressure
This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that the medication be discontinued prior to any surgery. In addition, any surgical incision should be fully healed prior to starting or restarting the medication. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.
This medication can cause a tear in the intestinal wall, also called a gastrointestinal perforation. Signs of this can include: new or worsening pain in the abdomen, new abdominal swelling, chills, fever, constipation, nausea or vomiting. If you experience any of these, contact your healthcare provider immediately or go to the emergency room.
Reversible Posterior Leukoencephalopathy Syndrome (RPLS)
A neurologic complication, reversible posterior leukoencephalopathy syndrome, has been reported. If you experience headache, seizure, confusion, blindness or other visual changes, inform your healthcare provider right away.
Blood Clots, Heart Attack and Stroke
This medication can increase the risk of blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes.
This medication can cause hypothyroidism (under active thyroid). Your provider will perform blood tests to check the function of your thyroid and treat this side effect if it develops. Symptoms of thyroid problems include: tiredness, feeling hot or cold, change in your voice, weight gain or loss, hair loss and muscle cramps.
This medication can cause an increase in the amounts of protein in your urine. Your healthcare team will monitor your kidney function and protein in your urine throughout treatment with this medication.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 3 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.