Cyramza
Cyramza (ramucirumab) is a targeted treatment for many types of cancer, including stomach cancer, non-small lung cancer (NSCLC), and colorectal cancer. Depending on the cancer, you might receive Cyramza (ramucirumab) by itself or with other anticancer treatments. It’s given as an infusion through the vein (IV) given once every 2 or 3 weeks, so it can be a convenient option. Some common side effects of Cyramza (ramucirumab) include tiredness, diarrhea, and bloody nose.
What is Cyramza (ramucirumab)?
What is Cyramza (ramucirumab) used for?
- Advanced or metastatic stomach cancer, after first-choice treatments no longer work, by itself or together with paclitaxel (Taxol)
- Metastatic non-small cell lung cancer (NSCLC) with certain EGFR mutations, together with erlotinib (Tarceva) as first-choice treatment
- Metastatic NSCLC, together with docetaxel (Taxotere) after first-choice treatments no longer work
- Metastatic colon cancer, together with chemotherapy after first-choice treatment’s stop working
- Advanced liver cancer after treatment with Nexavar (sorafenib)
How Cyramza (ramucirumab) works
Cyramza (ramucirumab) is a targeted therapy that works by blocking VEGF receptors. The VEGF receptor is a protein on the surface of cells in the body. It helps cells connect with blood vessels, which supply nutrients needed for the cells to grow and divide. By blocking the VEGF receptor, Cyramza (ramucirumab) stops tumors from getting nutrients and growing.
Drug facts
More on Cyramza (ramucirumab) essentials
Side effects of Cyramza (ramucirumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Fatigue (57%)
- Low blood cell counts (up to 54%)
- Diarrhea (32%)
- Bloody nose (31%)
- Swelling in the arms and legs (25%)
- High blood pressure (25%)
- Mouth sores (20%)
Less Common Side Effects
- Bleeding in the stomach
Please note: These side effects were reported by people who took Cyramza (ramucirumab) with paclitaxel (Taxol) for stomach cancer in a clinical study.
Cyramza (ramucirumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe bleeding: lightheadedness, black or bloody stools, coughing up blood or vomit that looks like coffee grounds
- Stomach or intestinal injury: severe vomiting, diarrhea, abdominal pain that doesn't go away
- Blood clots in the arteries: chest pain, sudden severe headaches, trouble breathing, sudden changes in speech or vision
- High blood pressure: severe headache, lightheadedness, confusion
- Posterior reversible encephalopathy syndrome: headache, feeling sluggish or confused, blindness
- Infusion-related reactions: chest pain, tremors, back pain, chills, trouble breathing, feeling flushed
The following Cyramza (ramucirumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Dizziness, loss of balance or coordination, confusion or trouble speaking
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low thyroid levels (hypothyroidism)—unusual weakness or fatigue, increased sensitivity to cold, constipation, hair loss, dry skin, weight gain, feelings of depression
- Stomach pain that is severe, does not go away, or gets worse
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Cyramza (ramucirumab)
Pros
- Given as an infusion every 2 to 3 weeks
- Short infusion time (about 30 minutes, after the 1st infusion)
- More precisely targeted than traditional chemotherapy
Cons
- Can slow down wound healing
- Can cause tiredness and raise blood pressure
- Can harm the unborn baby
Pharmacist tips for Cyramza (ramucirumab)
- Your first Cyramza (ramucirumab) infusion will take about 1 hour. During this time, your healthcare team will monitor you for symptoms of infusion reactions, such as chest pain, chills, and tremors. If your first infusion goes smoothly, the future infusions will likely be shorter (around 30 minutes). To prevent infusion reactions, you’ll receive IV diphenhydramine (Benadryl) as a premedication before your Cyramza (ramucirumab) treatment.
- It’s uncommon, but you might have a reaction to the Cyramza (ramucirumab) infusion. Let your treatment team know if you notice trouble breathing, hives, itching, flushing, chills, or chest pain during your Cyramza (ramucirumab) infusion. They’ll need to slow, pause, or stop your Cyramza (ramucirumab) infusion to treat your reaction.
- Cyramza (ramucirumab) can raise your risk of bleeding. If you notice any bloody urine, bloody stool, coughing up blood, or vomit or stool that look like coffee grounds, seek medical attention right away.
- Let your healthcare team know if you’re planning to undergo surgery or other procedures. Cyramza (ramucirumab) can slow down wound healing, so your provider might need to adjust your treatment schedule depending on the timing of your surgery. For example, you’ll need to stop Cyramza (ramucirumab) about a month before your procedure. And you won’t be able to restart Cyramza (ramucirumab) until your wounds have healed (at least 2 weeks after the procedure).
Common questions about Cyramza (ramucirumab)
No, Cyramza (ramucirumab) is a targeted therapy, not chemotherapy. Chemotherapy works by killing rapidly growing and dividing cells in the body, including tumor cells. Cyramza (ramucirumab) specifically targets cancer cells by working against proteins responsible for tumor growth. For some cancers, you might receive Cyramza (ramucirumab) along with chemotherapy as part of your treatment plan. For other cancers, you might receive Cyramza (ramucirumab) alone.
Cyramza (ramucirumab) and Avastin (bevacizumab) are both targeted therapies for cancer that work by blocking proteins responsible for forming blood supply to tumors. Since they work in a similar way, it’s not surprising that they have similar side effects, like infusion reactions, bleeding, blood clots, and slower wound healing. But, they can be used for different cancers and can’t necessarily be substituted for one another. They also haven’t been compared against each other in studies, so we can’t say for sure if one works better than the other.
Your first Cyramza (ramucirumab) infusion will take about an hour. Typically, your provider will give your first infusion over a longer period of time than following infusions because they want to monitor you for infusion-related reactions such as tremors, chills, and breathing problems. If your first infusion goes smoothly, you’ll be able to get future infusions over 30 minutes. It’s a good idea to plan to spend a few hours at the clinic for your Cyramza (ramucirumab) infusion, since you might have other labs or tests to do, or other infusions that are part of your treatment plan. It might help to bring water, a snack, and an activity to help pass the time, like a book or music.
Usually, you’ll take Cyramza (ramucirumab) for as long as it’s working to treat your cancer and you’re tolerating the medication. Your provider will do scans periodically during treatment to check that your treatment’s still working. If they see your cancer growing or spreading on the scans, that could be a sign that the medication’s stopped working and you’ll need to change your treatment plan. If you’re having trouble with side effects, like fatigue, bleeding, or blood clots, you might also need to stop treatment with Cyramza (ramucirumab).
Fatigue is a common Cyramza (ramucirumab) side effect. It’s a good idea to stay well-rested, eat well, and drink plenty of water while you’re receiving Cyramza (ramucirumab) treatment. You might need to take short naps or schedule activities when you have more energy. If fatigue is disrupting your daily activities, talk with your healthcare team. They might have other recommendations to help with your fatigue, or adjust your treatment plan to help with your symptoms.
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Risks and warnings for Cyramza (ramucirumab)
Cyramza (ramucirumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe bleeding
- Risk factors: Taking medications that raise your risk of bleeding
Cyramza (ramucirumab) can raise your risk of bleeding, which can happen anywhere in the body and can be serious. Your risk is even higher if you’re taking other medications that can cause bleeds. Contact your healthcare team if you have bleeding that’s difficult to stop or if you notice symptoms of bleeding on the inside of your body, such as lightheadedness, black or bloody stools, or coughing up blood or vomit that looks like coffee grounds. Your provider will likely ask you to stop Cyramza (ramucirumab) if you experience bleeding.
Stomach or intestinal injury
In rare cases, Cyramza (ramucirumab) can injure the digestive system, including damage or tears in the stomach or intestines, which can be life-threatening. Contact your provider if you have severe vomiting, diarrhea, or stomach pain that doesn't go away. Your provider will likely ask you to stop Cyramza (ramucirumab) if you experience stomach tears.
Surgery and wound healing problems
Cyramza (ramucirumab) can slow down wound healing. Talk with your healthcare team if you’re planning to have surgery while receiving treatment with Cyramza (ramucirumab). If you need elective surgery, you’ll need to pause Cyramza (ramucirumab) treatment for at least 4 weeks before surgery. You won’t be able to restart Cyramza (ramucirumab) for at least for 2 weeks after surgery and until your wound has properly healed.
Blood clots in the arteries
There have been reports of blood clots in people taking Cyramza (ramucirumab), specifically blood clots in the arteries causing heart attacks and strokes. These are quite rare, but very dangerous. Call 911 or get medical attention right away if you have chest pain, sudden severe headaches, trouble breathing, or sudden changes in your speech or vision. If you have a heart attack or stroke while taking Cyramza (ramucirumab), your provider will likely stop treatment and change your care plan.
High blood pressure
- Risk factors: Taking other medications that can raise blood pressure
High blood pressure is a common, mild side effect of Cyramza (ramucirumab), but can be severe or serious in certain situations. Your provider will check your blood pressure before you start the medication, and then you’ll need to check your blood pressure at least every 2 weeks. If your blood pressure is high, your provider might pause Cyramza (ramucirumab) and have you start blood pressure-lowering medications. If your blood pressure is difficult to control, your provider might consider other medications to treat the cancer. Let your healthcare team know if you have symptoms of dangerously high blood pressure, such as severe headache, lightheadedness, or confusion.
Infusion-related reactions
Some people have experienced very serious reactions from the Cyramza (ramucirumab) infusion. To prevent serious reactions, your provider will give you IV antihistamines before each infusion. If you do have a reaction, your care team might slow down or stop the infusion and treat you with medications, such as corticosteroids or antihistamines, to ease your symptoms. If your reaction isn't too severe, your care team might restart the infusion at a slower rate. But if you have a serious reaction, then your provider might have you stop Cyramza (ramucirumab) and change your treatment plan. Symptoms can include chest pain, tremors, back pain, chills, trouble breathing, and feeling flushed.
Liver problems
In studies, some people with liver problems who took Cyramza (ramucirumab) had signs of their liver problems worsening. This led to symptoms such as confusion, fluid buildup (ascites), and kidney problems (hepatorenal syndrome). If you have a history of liver problems, talk with your provider about the risks and benefits of Cyramza (ramucirumab) treatment prior to starting.
Posterior reversible encephalopathy syndrome
Posterior reversible encephalopathy syndrome (PRES) is a very rare side effect of Cyramza (ramucirumab) that can be fatal. Let your provider know if you have any symptoms of PRES, like headache, feeling sluggish or confused, or blindness.
Symptoms can appear anytime during treatment. If you develop symptoms, your provider will confirm whether or not you have PRES by ordering a brain scan called a magnetic resonance imaging (MRI). If you do have PRES, then it’s very likely that your provider will ask you to stop Cyramza (ramucirumab) treatment. Typically, symptoms of PRES go away within days after you stop this medication.
Kidney problems
Cyramza (ramucirumab) raises the risk of kidney problems, which can be serious. Your provider will monitor your kidney health through lab work and taking urine samples while you’re receiving this medication. If you develop kidney problems, your provider might pause treatment until your kidney gets better, then restart the medication at a lower dose. Talk to your provider if you notice any changes in how much you urinate or any blood in your urine so they can check for kidney issues.
Thyroid problems
Cyramza (ramucirumab) can cause low levels of thyroid hormone, an important hormone needed for your body to function normally. Your provider will check thyroid tests before starting treatment, then regularly while you are on this medication to make sure your thyroid hormone levels are within normal range. Let your provider know if you experience symptoms of thyroid problems, such as tiredness, weight gain, and dry skin.
Harm to the unborn baby
Cyramza (ramucirumab) can cause harm to unborn babies. If you’re a female able to have children, you’ll need to do a pregnancy test before starting Cyramza (ramucirumab). Use effective birth control while taking the medication and for 3 months after the last dose.
Cyramza (ramucirumab) dosage
Typical dosage for Cyramza (ramucirumab)
Your specific dose will depend on your weight and the cancer you’re getting treatment for.
- Stomach cancer, colon cancer, or liver cancer: The typical dose is 8 mg/kg as an infusion through the vein every 2 weeks.
- NSCLC: The typical dose is 10 mg/kg as an infusion through the vein every 2 to 3 weeks, depending on what other anticancer medications you're taking.
