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ramucirumab (Cyramza)

Indications: - advanced gastric cancer - gastroesophageal junction adenocarcinoma - for use in patients with unresectable gastric cancer or metastatic gastric cancer after treatment with fluoropyrimidine- (5-fluoruracil) or platinum-containing (cisplatin) therapy - may be used in combination with paclitaxel (Taxol) - in combination with FOLFIRI (after ramucirumab) for treatment of metastatic colorectal cancer [2] - metastatic non-small cell lung cancer in combination with docetaxel - disease progression on or after platinum-based chemotherapy - disease progression on erlotinib or crizotinib [3,4] * improves median survival 5.2 vs 3.8 months with placebo Benefit/risk: - overall survival with ramucirumab versus placebo (13.3 vs 11.7 months) for metastatic colorectal cancer [2] Adverse effects: - diarrhea - hypertension Mechanism of action: - angiogenesis inhibitor - directly targets the VEGF receptor 2 (VEGFR2) via ligand- binding site [2] - blocks the blood supply to tumor

General

pharmaceutical angiogenesis inhibitor (angiostatic agent) antineoplastic agent (chemotherapeutic agent)

References

  1. Kelly KJ FDA Approves Drug to Treat Advanced Stomach Cancer. Physician's First Watch, April 23, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - FDA News Release: April 21, 2014 FDA approves Cyramza for stomach cancer. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394107.htm
  2. Tabernero J et al. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): A randomised, double-blind, multicentre, phase 3 study. Lancet Oncol 2015 May; 16:499 PMID: 25877855 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2815%2970127-0/abstract
  3. 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(9944):665-673. PMID: 24933332
  4. Perol M, Ciuleanu TE, Arrieta O et al Quality of life results from the phase 3 REVEL randomized clinical trial of ramucirumab-plus-docetaxel versus placebo- plus-docetaxel in advanced/metastatic non-small cell lung cancer patients with progression after platinum-based chemotherapy. Lung Cancer. 2016 Mar;93:95-103. Epub 2016 Jan 19. PMID: 26898621