Ramucirumab

(Cyramza®)

Cyramza®

Drug updated on 7/23/2024

Dosage FormInjection (intravenous; 100 mg/10 mL [10 mg/mL], 500 mg/50 mL [10 mg/mL])
Drug ClassHuman vascular endothelial growth factor receptor 2 antagonists
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated as a single agent or in combination with paclitaxel, for treatment of advanced or metastatic gastric or gastro-esophageal junction adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy.
  • Indicated in combination with erlotinib, for first-line treatment of metastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) mutations.
  • Indicated in combination with docetaxel, for treatment of metastatic non-small cell lung cancer with disease progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving CYRAMZA.
  • Indicated in combination with FOLFIRI, for the treatment of metastatic colorectal cancer with disease progression on or after prior therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine.
  • Indicated as a single agent, for the treatment of hepatocellular carcinoma in patients who have an alpha fetoprotein of ≥400 ng/mL and have been treated with sorafenib.

Latest News

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Summary
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  • Ramucirumab (Cyramza) is indicated for the treatment of various cancers, including non-small cell lung cancer, gastric or gastro-esophageal junction adenocarcinoma, hepatocellular carcinoma, and metastatic colorectal cancer. It can be used as a single agent or in combination with other drugs such as paclitaxel, erlotinib, and docetaxel.
  • The information was derived from 20 systematic reviews/meta-analyses related to ramucirumab's use across different indications.
  • In comparison to EGFR-TKIs and chemotherapy for non-small cell lung cancer patients with specific genetic mutations (EGFR mutations), ramucirumab combined with docetaxel showed improved overall survival rates after prior therapy failure.
  • For gastric/gastro-esophageal junction adenocarcinoma patients, ramucirumab plus chemotherapy demonstrated superior outcomes in terms of overall survival compared to chemotherapy alone. This indicates that it offers a valuable option in both the first-line and later settings.
  • When treating hepatocellular carcinoma, particularly for patients with elevated alpha-fetoprotein levels post-sorafenib treatment, ramucirumab has shown effectiveness in improving overall survival, positioning it as a viable second-line therapy option.
  • In cases of metastatic colorectal cancer progressing after first-line therapy, ramucirumab, combined with FOLFIRI, improved both progression-free survival rates and overall survival rates, emphasizing its contribution towards treatment escalation strategies.
  • Across all these indications mentioned above, the safety profile remained consistent, aligning closely with adult experiences without any new safety signals emerging from comparative analyses, even within pediatric populations or specific patient subsets which were part of this study review process.
  • The effectiveness varied across different types of cancers, highlighting the importance of patient selection based on factors like molecular subgroups, etc., thus underscoring the necessity of personalized therapeutic strategies considering disease type and progression patterns along with prior treatment history.

Product Monograph / Prescribing Information

Document TitleYearSource
Cyramza (ramucirumab) prescribing information.2022FDA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Front-line therapy for brain metastases and non-brain metastases in advanced epidermal growth factor receptor-mutated non-small cell lung cancer: A network meta-analysis.2023Chinese Medical Journal
Clinical outcomes of ramucirumab plus docetaxel in the treatment of patients with non-small cell lung cancer after immunotherapy: A systematic literature review.2023Frontiers in Oncology
First-line therapeutic strategy for patients with advanced non-small cell lung cancer with Leu858Arg epidermal growth factor receptor mutations: A Bayesian network meta-analysis.2023Therapeutic Advances in Chronic Disease
Efficacy and safety of first-line therapies in EGFR-mutated advanced non-small-cell lung cancer: A network meta-analysis.2022Future Oncology
Overall survival benefits of first-line treatments for Asian patients with advanced EGFR-mutated NSCLC harboring L858R mutation: A systematic review and network meta-analysis.2022JTO Clinical Research Reports
Impact of smoking status in combination treatment with EGFR tyrosine kinase inhibitors and anti-angiogenic agents in advanced non-small cell lung cancer harboring susceptible EGFR mutations: systematic review and meta-analysis.2022Journal of Clinical Medicine
Comparative efficacy of treatments for previously treated patients with advanced esophageal and esophagogastric junction cancer: A network meta-analysis.2021PLoS One
Comparative efficacy and safety of anti-PD-1/PD-L1 immune checkpoint inhibitors for refractory or relapsed advanced non-small-cell lung cancer-a systematic review and network meta-analysis.2021Cancers
Toward a treatment sequencing strategy: A systematic review of treatment regimens in advanced gastric cancer/gastroesophageal junction adenocarcinoma.2021The Oncologist
Ramucirumab in patients with previously treated advanced hepatocellular carcinoma: Impact of liver disease aetiology.2021Liver International
Systemic therapy and sequencing options in advanced hepatocellular carcinoma: A systematic review and network meta-analysis.2020JAMA Oncology
Optimizing survival and the changing landscape of targeted therapy for intermediate and advanced hepatocellular carcinoma: A systematic review.2020Journal of the National Cancer Institute
Role of systemic treatment for advanced/metastatic gastric carcinoma in the third-line setting: A Bayesian network analysis.2020Frontiers in Oncology
Systemic therapy for previously treated advanced gastric cancer: A systematic review and network meta-analysis.2019Critical Reviews in Oncology / Hematology
Comparative survival benefit of currently licensed second or third line treatments for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) negative advanced or metastatic non-small cell lung cancer: a systematic review and secondary analysis of trials.2019BMC Cancer

Clinical Practice Guidelines