Key takeaways:
There are many ways to treat lung cancer. One way is to block the cancer’s blood supply with medications like Avastin (bevacizumab) or Cyramza (ramucirumab).
Avastin and Cyramza are usually used in combination with chemotherapy, immunotherapy, or other targeted therapies. They haven’t been directly compared to one another for lung cancer.
Avastin and Cyramza are used in different situations depending on your type of lung cancer and other treatments you’ve received. Your cancer specialist can decide if either medication is right for you.
These days, there’s a long list of medications that can treat non-small cell lung cancer (NSCLC). They work in many ways, and they all have unique goals that they want to achieve. One popular group of medications blocks the growth of blood vessels, which includes medications like Avastin (bevacizumab) and Cyramza (ramucirumab).
Read on to learn how these medications work, when they can be used, and what side effects to look out for.
What is Avastin?
Avastin is a monoclonal antibody medication that treats NSCLC. It targets vascular endothelial growth factor (VEGF), a protein that helps your body make new blood vessels. Because it targets VEGF, it’s considered a targeted therapy medication — not chemotherapy. It’s also used to control other different types of cancer, such as colorectal cancer.
There are also three medications that are very similar to Avastin. These are called biosimilar medications. These include:
Because they’re biosimilars, they can be prescribed in place of Avastin. This is similar to the relationship between brand and generic medications. The type of bevacizumab used will depend on your insurance status and cancer center.
What is Cyramza?
Cyramza is another monoclonal antibody medication that treats NSCLC. It also stops the growth of new blood vessels — similar to Avastin — but it works a bit differently. We’ll discuss this more below.
Cyramza can also be used to treat other cancers, like colorectal and liver cancer.
How do Avastin and Cyramza work for non-small cell lung cancer?
Tumors can grow by using a process called angiogenesis. This process helps create new blood vessels in your body. But angiogenesis supplies tumors with blood too — this helps them grow and multiply.
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Avastin and Cyramza both stop blood vessels from growing, so they’re called angiogenesis inhibitors (blockers). Avastin binds to a small protein called VEGF, whereas Cyramza binds to VEGF receptors (chemical binding sites) on tumor cells and prevents VEGF proteins from attaching to them.
They work slightly differently, but they both turn off the growth of new blood vessels. They can help slow a tumor’s growth.
How are Avastin and Cyramza dosed and given?
Avastin and Cyramza are given as intravenous (IV) infusions into a vein. When given for NSCLC, Avastin is usually infused once every 3 weeks. Cyramza is infused once every 2 or 3 weeks depending on your treatment plan.
Avastin and Cyramza aren’t usually given by themselves. That’s because if a tumor is unresectable (can’t be removed with surgery), advanced, or metastatic (spread to other parts of the body) the classic treatment is generally chemotherapy. Chemotherapy works by killing cells that grow and divide quickly, like cancer cells.
The chemotherapy you’d receive depends on the type of lung cancer you have. There are squamous cell carcinomas that grow from squamous cells, which line airways. Then there are non-squamous cells, which include everything else.
How effective are Avastin and Cyramza for treating non-small cell lung cancer?
Your cancer specialist has many medication options to choose from. The best treatment for you will depend on the type of lung cancer you have, your cancer stage, and any mutations your cancer has.
Let’s walk through some situations that analyze Avastin and Cyramza’s effectiveness.
Non-small cell lung cancer with no mutations
In NSCLC without mutations, Avastin or Cyramza may be considered alongside traditional chemotherapy treatments to help improve survival time.
Avastin
Avastin can treat nonsquamous NSCLC, but not squamous NSCLC. It can be given in combination with chemotherapy, like Platinol (carboplatin) and Taxol (paclitaxel). Results vary for everyone, but when added to chemotherapy, Avastin improved survival by 2 months in one study.
Treating this form of NSCLC may also include immunotherapy, which helps your own immune system fight cancer more effectively. In another study, chemotherapy given with both Avastin and Tecentriq (atezolizumab) — an immunotherapy medication — improved survival compared to chemotherapy and Tecentriq alone.
Cyramza
Cyramza can be used for either nonsquamous or squamous NSCLC when it’s given in combination with Taxotere (docetaxel), a chemotherapy medication. This is based on data showing that this combination can improve survival compared to receiving Taxotere alone.
Non-small cell lung cancer with EGFR mutations
If your NSCLC has a mutation called an EGFR mutation, targeted therapies like Tagrisso (osimertinib) or Tarceva (erlotinib) can be used. Avastin and Cyramza may be given alongside one of them to help improve survival time.
Avastin
In one trial, people with EGFR mutations who had never received any cancer treatment were given Tarceva with or without Avastin. The researchers found that taking Avastin with Tarceva together didn’t improve survival, so Avastin may not be helpful for this form of NSCLC.
However, another EGFR inhibitor, Tagrisso, is generally regarded as a first-choice treatment in the U.S. There just isn’t much data yet that looks at how well Avastin and Tagrisso perform together.
Cyramza
A similar study looked at the effectiveness of Tarceva with or without Cyramza for this form of NSCLC. The researchers found that people who received Tarceva and Cyramza together had better outcomes than people who didn’t receive Cyramza.
But like the study with Avastin, take this data with a grain of salt. This is because Tagrisso is now a preferred option for EGFR-mutated lung cancers. There isn’t enough data yet to say how well Cyramza and Tagrisso work together.
So, is one preferred over the other?
Not exactly. Although they work in a similar way, Avastin and Cyramza haven’t been compared against each other in clinical studies. So we can’t say for sure. They’re also used in different settings of advanced or metastatic NSCLC:
| Cancer type | Line of therapy | Possible medications |
|---|---|---|
| Nonsquamous NSCLC (no mutations) |
Initial treatment | Avastin with chemotherapy |
| Nonsquamous or squamous NSCLC (no mutations) |
Alternative treatment | Cyramza with chemotherapy |
| Nonsquamous NSCLC (EGFR mutation) |
Initial treatment | Avastin and Tarceva or Cyramza and Tarceva |
What are the common side effects of Avastin and Cyramza?
Both Avastin and Cyramza can cause high blood pressure. One sign that your blood pressure is too high is protein in your urine, which your cancer specialist should monitor for. Let your cancer specialist know if you have issues with high blood pressure.
Other common side effects include:
Bruising and bleeding (nose bleeds)
Headache
Taste changes
Dry skin
Back pain
Watery eyes
As monoclonal antibodies, Avastin and Cyramza can both also cause infusion reactions. But these medications are usually given at a hospital or infusion center, so you will be monitored closely for these reactions during and after your infusions.
What are the serious side effects of Avastin and Cyramza?
Rare but serious side effects of both Avastin and Cyramza may include:
Serious bleeding, including coughing up blood or vomiting blood
Very high blood pressure
Kidney damage
Heart failure
Complications from blood clots, including strokes or heart attacks
Holes in your stomach or intestines
Abnormal passages in the body (fistulas)
Vision loss
Seizures
Delayed wound healing
If you notice any signs of serious side effects after you leave your infusion site, make sure to contact your care team right away.
How much do Avastin and Cyramza cost?
Specific prices vary for everyone, but Avastin and Cyramza are both expensive. Because of this, you may receive a biosimilar version of Avastin instead of the original. Avastin’s three biosimilars are typically cheaper than Avastin itself. Cyramza doesn’t currently have any biosimilars.
Avastin and Cyramza are usually billed through the medical benefit of your health insurance, if applicable. Your insurance may cover some or all of your treatment cost. If your copay is too high, financial assistance programs may help. Genentech (Avastin’s manufacturer) and Eli Lilly (Cyramza’s manufacturer) both have savings programs for qualifying people.
Your cancer care team can also help connect you to other savings programs, based on your location and individual situation.
Can you take Avastin and Cyramza together for non-small cell lung cancer?
No. Since Avastin and Cyramza work similarly, they are not used together. They’re used in combination with chemotherapy, immunotherapy, or other targeted therapy medications.
The bottom line
Avastin and Cyramza are used in combination with chemotherapy, immunotherapy, or targeted therapies. But they haven’t been compared to one another, and they’re used differently depending on the type of NSCLC you have and other treatments you’ve received. Your cancer specialist can help you decide if treatment with either Avastin or Cyramza is right for you.
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