Ramucirumab
Antineoplastic monoclonal antibodies
Antineoplastic monoclonal antibodiesHigh alert
An error with this medicine can cause serious harm: double checks and protocols are used.Pregnancy: avoid
Avoid in pregnancy. A pregnancy test is done before starting and contraception is used during treatment and for months after; it may reduce female fertility, and breastfeeding is…
Human antibody against VEGF receptor 2 that blocks tumour blood-vessel growth. For gastric, lung, colorectal and liver cancer; raises blood pressure.
Quick facts
- Group
- Antineoplastic monoclonal antibodies
- Target
- Vascular endothelial growth factor receptor 2 (VEGFR2, KDR) on endothelial cells
- Used for
- Advanced or metastatic gastric
- Key effects
- High blood pressure · Diarrhoea
- Monitor
- Blood pressure at every visit · Urine protein
- ATC
- L01FG02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Tumours grow new blood vessels by releasing VEGF, which acts mainly through VEGF receptor 2 on endothelial cells. Ramucirumab is a human IgG1 antibody that binds VEGFR2 and blocks its ligands from binding, so endothelial cells are not stimulated and new vessel growth is held back. Unlike bevacizumab, which traps the VEGF ligand, it blocks the receptor.
- Ramucirumab binds VEGFR2 on endothelial cells
- VEGF can no longer activate the receptor
- Tumour blood-vessel growth is held back
Indications
- Advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma after earlier chemotherapy, alone or with paclitaxel. Gastric cancer →
- Metastatic non-small cell lung cancer: with docetaxel after platinum chemotherapy, or with erlotinib first line when EGFR is mutated. Lung cancer →
- Metastatic colorectal cancer with FOLFIRI after bevacizumab, oxaliplatin and a fluoropyrimidine. Colorectal cancer →
- Hepatocellular carcinoma with high alpha-fetoprotein after sorafenib. Hepatocellular carcinoma →
Adverse effects
Common
- High blood pressure
- Diarrhoea
- Mouth and throat sores
- Swelling and weight gain; headache, tiredness
Contraindications
- No absolute contraindications in the label apart from hypersensitivity; see the warnings
Key interactions
- Paclitaxel, docetaxel, erlotinib or FOLFIRI (combination regimens)
- Intended combinations; the toxicities of each drug add up (for example low blood counts and diarrhoea).
What is monitored
- Blood pressure at every visit
- Urine protein
- Thyroid and liver function
- Signs of bleeding and wound healing
Administration and safety
- Intravenous infusion by a doctor or nurse in a hospital or clinic; the patient is watched for infusion reactions.
- Any unhealed wound, or a planned surgery or dental procedure, is reported to the treating team first.
Pregnancy and breastfeeding
Avoid in pregnancy. A pregnancy test is done before starting and contraception is used during treatment and for months after; it may reduce female fertility, and breastfeeding is avoided.
Nursing care
- Check blood pressure before each dose.
- Ask about high blood pressure, thyroid or liver disease and unhealed wounds before starting.
- Teach the signs of stroke and heart attack, and to report bleeding, black stools, severe abdominal pain or foamy urine.
- Tell the surgeon or dentist before any procedure.
Pharmacokinetics
- Absorption
- Intravenous infusion every two to three weeks.
- Half-life
- About 14 days (mean).
Test yourself
Think of the answer, then tap the question to see it.
How does ramucirumab differ from bevacizumab?
Ramucirumab blocks the receptor VEGFR2; bevacizumab binds the VEGF ligand.
Which vital sign must be checked before every ramucirumab dose?
Blood pressure.
A patient on ramucirumab notices foamy urine. What does it suggest?
Protein in the urine, a known effect of VEGF pathway blockade; urine protein is checked.
Connections
← Back to the class: Antineoplastic monoclonal antibodies
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Ramucirumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2020); Ramucirumab - NCI (National Cancer Institute (U.S.), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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