# Ramucirumab

Source: https://onco.cc/drugs/ramucirumab/  
OnCo record `ramucirumab` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

An antibody that blocks the VEGF receptor, approved in liver cancer only for patients with a high AFP blood level, the first biomarker-selected HCC drug.

## Summary

Ramucirumab is a fully human IgG1 antibody that binds the extracellular domain of VEGFR2, blocking VEGF-A, C and D signalling at the receptor rather than the ligand. It is approved in second-line gastric cancer alone or with paclitaxel (RAINBOW, 2014: OS 9.6 versus 7.4 months), in NSCLC with docetaxel (REVEL) and with erlotinib in EGFR-mutant disease, in colorectal cancer with FOLFIRI (RAISE) and in HCC. In HCC, REACH-2 showed overall survival of 8.5 versus 7.3 months in sorafenib-pretreated patients with AFP of 400 ng/mL or more (HR 0.71), after REACH failed in unselected patients, making it the first biomarker-selected HCC drug. Hypertension (25%) and proteinuria are the main toxicities. Its gastric role is being eroded by trastuzumab deruxtecan (DESTINY-Gastric04) and Claudin drugs. For a newcomer, it is the VEGF-receptor antibody given every 2 weeks in several cancers.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Cyramza
- Modality: Monoclonal antibody (anti-VEGFR2)
- Mechanism: Fully human IgG1 binding VEGFR2 ectodomain, blocking VEGF-A/C/D signalling.
- Approvals: US 2014: Gastric cancer; NSCLC; US 2019: HCC with AFP ≥400 ng/mL after sorafenib; England (NICE) 2016: Locally advanced or metastatic non-small-cell lung cancer progressing after platinum-based chemotherapy, with docetaxel: not recommended
- Dosing: Intravenous; 8 mg/kg every 2 weeks
- Toxicity (grade 3+): Hypertension 13%; Proteinuria 2%

## Notes

- In stomach cancer: RAINBOW (with paclitaxel) and REGARD (alone) established ramucirumab as second-line treatment of gastric and gastro-oesophageal junction cancer in 2014, given at 8 mg/kg on days 1 and 15 with paclitaxel 80 mg/m2 on days 1, 8 and 15 of a 28-day cycle; it is held for uncontrolled hypertension or proteinuria above 2 g in 24 hours. It is now the comparator arm that trastuzumab deruxtecan (DESTINY-Gastric04) and the CLDN18.2 ADC (CLARITY-Gastric01) have beaten.
- In colorectal cancer RAISE showed median overall survival 13.3 against 11.7 months when ramucirumab was added to second-line FOLFIRI after progression on first-line bevacizumab, oxaliplatin and a fluoropyrimidine. It has no NICE recommendation for colorectal cancer and is not routinely funded in England.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Ramucirumab
- FDA label: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125477s040lbl.pdf
- NICE TA403: ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer (not recommended): https://www.nice.org.uk/guidance/ta403

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/), [Claudin 18.2-positive gastric cancer](https://onco.cc/cancers/gastric-cldn18-2-positive/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [HER2-positive gastric cancer](https://onco.cc/cancers/gastric-her2-positive/), [KRAS G12C-mutant non-small-cell lung cancer](https://onco.cc/cancers/kras-g12c-nsclc/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal and junctional adenocarcinoma](https://onco.cc/cancers/oesophageal-adenocarcinoma/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [PD-L1-high gastric cancer](https://onco.cc/cancers/gastric-pdl1-high/), [PD-L1-high non-small-cell lung cancer without a driver mutation](https://onco.cc/cancers/pdl1-high-nsclc/), [Squamous cell carcinoma of the lung](https://onco.cc/cancers/lung-squamous-cell-carcinoma/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- targets: [VEGF / VEGFR](https://onco.cc/targets/vegf/)
- companies: [Eli Lilly (incl. Loxo)](https://onco.cc/companies/eli-lilly/)
- pathways: [Colorectal cancer (KEGG map)](https://onco.cc/pathways/colorectal-cancer-signalling/), [Gastric cancer (KEGG map)](https://onco.cc/pathways/gastric-cancer-signalling/), [Hepatocellular carcinoma (KEGG map)](https://onco.cc/pathways/hepatocellular-carcinoma-signalling/), [Proteoglycans in cancer](https://onco.cc/pathways/proteoglycans-in-cancer/), [The angiogenic switch & tumour vessels](https://onco.cc/pathways/angiogenic-switch/), [VEGF angiogenesis](https://onco.cc/pathways/vegf-angiogenesis/)
- terms: [Alpha-fetoprotein (AFP)](https://onco.cc/terms/afp/), [Lung cancer drugs in England: what NICE has recommended](https://onco.cc/terms/lung-uk-drug-access/), [Lung cancer: the failed and stopped programmes, and why](https://onco.cc/terms/lung-failed-programmes/)
- trials: [A Master Protocol (LY900023) That Includes Several Clinical Trials of Drugs for Children and Young Adults With Cancer](https://onco.cc/trials/nct05999994/), [A Platform Study in Non-Small Cell Lung Cancer (NSCLC)](https://onco.cc/trials/nct06996782/), [A Study of Novel Combinations in Non-Small Cell Lung Cancer (NSCLC)](https://onco.cc/trials/nct07098338/), [A Study of Ramucirumab (LY3009806) in Combination With Erlotinib in Previously Untreated Participants With EGFR Mutation-Positive Metastatic NSCLC (RE](https://onco.cc/trials/nct02411448/), [A Study of Ramucirumab (LY3009806) or Merestinib (LY2801653) in Advanced or Metastatic Biliary Tract Cancer](https://onco.cc/trials/nct02711553/), [A Study of TRK-950 When Used in Combination With Ramucirumab and Paclitaxel in Patients With Gastric Cancer](https://onco.cc/trials/nct06038578/), [A Study to Assess Intravenous (IV) Telisotuzumab Adizutecan Compared to Standard of Care in Adult Participants Previously Treated, EGFR Wildtype, Locally Advanc](https://onco.cc/trials/nct07821684/), [Adding the Immunotherapy Drug Cemiplimab to Usual Treatment for People With Advanced Non-Small Cell Lung Cancer Who Had Previous Treatment With Platinum Chemoth](https://onco.cc/trials/nct06616584/), [Cinrebafusp Alfa in Combination With Ramucirumab and Paclitaxel in HER2-High Gastric or GEJ Adenocarcinoma and in Combination With Tucatinib in HER2-Low Gastric or GEJ Andenocarinoma](https://onco.cc/trials/nct05190445/), [CLARITY-Gastric 01](https://onco.cc/trials/clarity-gastric01/), [DESTINY-Gastric04](https://onco.cc/trials/destiny-gastric04/), [Global, Multicenter Study of AMT-116 Versus Investigator's Choice in Participants With Advanced or Metastatic Non-squamous EGFR-Wildtype Non-Small Cell Lung Can](https://onco.cc/trials/nct07718737/), [Lung-MAP (SWOG S1400 and S1900)](https://onco.cc/trials/lung-map/), [Lung-MAP S1800A: ramucirumab plus pembrolizumab](https://onco.cc/trials/lung-map-s1800a/), [RAINBOW](https://onco.cc/trials/rainbow/), [RAISE](https://onco.cc/trials/raise/), [REACH-2](https://onco.cc/trials/reach-2/), [REVEL](https://onco.cc/trials/revel/), [Safety and Efficacy of HCB101 in Combination With Multiple Agents in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06771622/), [SHR-A1811 for Subjects With Her2-positive Gastric Cancer and Gastroesophageal Junction Adenocarcinoma After Progression on or After First-line Anti-HER2 Therapy-containing Regimen](https://onco.cc/trials/nct06123494/), [Substudy 06D: Combination Therapies in Second Line (2L) Gastroesophageal Adenocarcinoma (MK-3475-06D/Keymaker-U06)](https://onco.cc/trials/nct06445972/), [Testing the Use of Combination Immunotherapy Treatment (N-803 [ALT-803] Plus Pembrolizumab) Against the Usual Treatment for Advanced Non-small Cell Lung Cancer](https://onco.cc/trials/nct05096663/), [Volrustomig Priming Regimens Exploratory Phase II Platform Study](https://onco.cc/trials/nct06448754/)
- people: [Min-Hee Ryu](https://onco.cc/people/ryu-min-hee/)
- key papers: [RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in previously treated advanced gastric cancer](https://onco.cc/key-papers/paper-rainbow-ramucirumab-paclitaxel-lancet-oncol-2014/)
- drugs: [Ziv-aflibercept](https://onco.cc/drugs/ziv-aflibercept/)

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JSON: https://onco.cc/api/v1/entities/ramucirumab.json