{"entity":{"id":"ramucirumab","kind":"drug","name":"Ramucirumab","aka":[],"tldr":"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.","status":"approved","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Ramucirumab","links":[{"label":"FDA label","url":"https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125477s040lbl.pdf"},{"label":"NICE TA403: ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer (not recommended)","url":"https://www.nice.org.uk/guidance/ta403"}],"tags":[],"related":[],"cancers":["hcc","gastric","nsclc","colorectal","lung-cancer"],"sections":[],"technologies":["monoclonal-antibody","antiangiogenic"],"targets":["vegf"],"drugs":[],"companies":["eli-lilly"],"institutions":[],"pathways":["vegf-angiogenesis"],"terms":["afp"],"trials":["nct02411448","nct06448754","nct07098338","nct06996782","nct06038578","nct05999994","nct06771622","nct05190445","nct06445972","nct06123494","rainbow","destiny-gastric04","raise","lung-map-s1800a"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"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."],"brand":"Cyramza","modality":"Monoclonal antibody (anti-VEGFR2)","mechanism":"Fully human IgG1 binding VEGFR2 ectodomain, blocking VEGF-A/C/D signalling.","approvals":[{"region":"US","year":2014,"indication":"Gastric cancer; NSCLC"},{"region":"US","year":2019,"indication":"HCC with AFP ≥400 ng/mL after sorafenib"},{"region":"England (NICE)","year":2016,"indication":"Locally advanced or metastatic non-small-cell lung cancer progressing after platinum-based chemotherapy, with docetaxel: not recommended","note":"TA403, published 24 August 2016, does not recommend ramucirumab with docetaxel within its marketing authorisation."}],"mechanismSteps":[],"dosing":{"route":"Intravenous","schedule":"8 mg/kg every 2 weeks"},"toxicity":[{"event":"Hypertension","anyGradePct":25,"grade3PlusPct":13,"note":"REACH-2"},{"event":"Proteinuria","anyGradePct":20,"grade3PlusPct":2,"note":"REACH-2"}],"access":[],"regulatoryEvents":[]},"route":"/drugs/ramucirumab/","neighbours":{"cancer":[{"id":"hcc-advanced","kind":"cancer","name":"Advanced hepatocellular carcinoma (BCLC C)","route":"/cancers/hcc-advanced/"},{"id":"gastric-cldn18-2-positive","kind":"cancer","name":"Claudin 18.2-positive gastric cancer","route":"/cancers/gastric-cldn18-2-positive/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"},{"id":"gastric-her2-positive","kind":"cancer","name":"HER2-positive gastric cancer","route":"/cancers/gastric-her2-positive/"},{"id":"kras-g12c-nsclc","kind":"cancer","name":"KRAS G12C-mutant non-small-cell lung cancer","route":"/cancers/kras-g12c-nsclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"oesophageal-adenocarcinoma","kind":"cancer","name":"Oesophageal and junctional adenocarcinoma","route":"/cancers/oesophageal-adenocarcinoma/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"},{"id":"gastric-pdl1-high","kind":"cancer","name":"PD-L1-high gastric cancer","route":"/cancers/gastric-pdl1-high/"},{"id":"pdl1-high-nsclc","kind":"cancer","name":"PD-L1-high non-small-cell lung cancer without a driver mutation","route":"/cancers/pdl1-high-nsclc/"},{"id":"lung-squamous-cell-carcinoma","kind":"cancer","name":"Squamous cell carcinoma of the lung","route":"/cancers/lung-squamous-cell-carcinoma/"}],"technology":[{"id":"antiangiogenic","kind":"technology","name":"Anti-angiogenic therapy","route":"/technologies/antiangiogenic/"},{"id":"monoclonal-antibody","kind":"technology","name":"Monoclonal antibodies","route":"/technologies/monoclonal-antibody/"}],"target":[{"id":"vegf","kind":"target","name":"VEGF / VEGFR","route":"/targets/vegf/"}],"company":[{"id":"eli-lilly","kind":"company","name":"Eli Lilly (incl. Loxo)","route":"/companies/eli-lilly/"}],"pathway":[{"id":"colorectal-cancer-signalling","kind":"pathway","name":"Colorectal cancer (KEGG map)","route":"/pathways/colorectal-cancer-signalling/"},{"id":"gastric-cancer-signalling","kind":"pathway","name":"Gastric cancer (KEGG map)","route":"/pathways/gastric-cancer-signalling/"},{"id":"hepatocellular-carcinoma-signalling","kind":"pathway","name":"Hepatocellular carcinoma (KEGG map)","route":"/pathways/hepatocellular-carcinoma-signalling/"},{"id":"proteoglycans-in-cancer","kind":"pathway","name":"Proteoglycans in cancer","route":"/pathways/proteoglycans-in-cancer/"},{"id":"angiogenic-switch","kind":"pathway","name":"The angiogenic switch & tumour vessels","route":"/pathways/angiogenic-switch/"},{"id":"vegf-angiogenesis","kind":"pathway","name":"VEGF angiogenesis","route":"/pathways/vegf-angiogenesis/"}],"term":[{"id":"afp","kind":"term","name":"Alpha-fetoprotein (AFP)","route":"/terms/afp/"},{"id":"lung-uk-drug-access","kind":"term","name":"Lung cancer drugs in England: what NICE has recommended","route":"/terms/lung-uk-drug-access/"},{"id":"lung-failed-programmes","kind":"term","name":"Lung cancer: the failed and stopped programmes, and why","route":"/terms/lung-failed-programmes/"}],"trial":[{"id":"nct05999994","kind":"trial","name":"A Master Protocol (LY900023) That Includes Several Clinical Trials of Drugs for Children and Young Adults With Cancer","route":"/trials/nct05999994/"},{"id":"nct06996782","kind":"trial","name":"A Platform Study in Non-Small Cell Lung Cancer (NSCLC)","route":"/trials/nct06996782/"},{"id":"nct07098338","kind":"trial","name":"A Study of Novel Combinations in Non-Small Cell Lung Cancer (NSCLC)","route":"/trials/nct07098338/"},{"id":"nct02411448","kind":"trial","name":"A Study of Ramucirumab (LY3009806) in Combination With Erlotinib in Previously Untreated Participants With EGFR Mutation-Positive Metastatic NSCLC (RE","route":"/trials/nct02411448/"},{"id":"nct02711553","kind":"trial","name":"A Study of Ramucirumab (LY3009806) or Merestinib (LY2801653) in Advanced or Metastatic Biliary Tract Cancer","route":"/trials/nct02711553/"},{"id":"nct06038578","kind":"trial","name":"A Study of TRK-950 When Used in Combination With Ramucirumab and Paclitaxel in Patients With Gastric Cancer","route":"/trials/nct06038578/"},{"id":"nct07821684","kind":"trial","name":"A Study to Assess Intravenous (IV) Telisotuzumab Adizutecan Compared to Standard of Care in Adult Participants Previously Treated, EGFR Wildtype, Locally Advanc","route":"/trials/nct07821684/"},{"id":"nct06616584","kind":"trial","name":"Adding the Immunotherapy Drug Cemiplimab to Usual Treatment for People With Advanced Non-Small Cell Lung Cancer Who Had Previous Treatment With Platinum Chemoth","route":"/trials/nct06616584/"},{"id":"nct05190445","kind":"trial","name":"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","route":"/trials/nct05190445/"},{"id":"clarity-gastric01","kind":"trial","name":"CLARITY-Gastric 01","route":"/trials/clarity-gastric01/"},{"id":"destiny-gastric04","kind":"trial","name":"DESTINY-Gastric04","route":"/trials/destiny-gastric04/"},{"id":"nct07718737","kind":"trial","name":"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","route":"/trials/nct07718737/"},{"id":"lung-map","kind":"trial","name":"Lung-MAP (SWOG S1400 and S1900)","route":"/trials/lung-map/"},{"id":"lung-map-s1800a","kind":"trial","name":"Lung-MAP S1800A: ramucirumab plus pembrolizumab","route":"/trials/lung-map-s1800a/"},{"id":"rainbow","kind":"trial","name":"RAINBOW","route":"/trials/rainbow/"},{"id":"raise","kind":"trial","name":"RAISE","route":"/trials/raise/"},{"id":"reach-2","kind":"trial","name":"REACH-2","route":"/trials/reach-2/"},{"id":"revel","kind":"trial","name":"REVEL","route":"/trials/revel/"},{"id":"nct06771622","kind":"trial","name":"Safety and Efficacy of HCB101 in Combination With Multiple Agents in Patients With Advanced Solid Tumors","route":"/trials/nct06771622/"},{"id":"nct06123494","kind":"trial","name":"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","route":"/trials/nct06123494/"},{"id":"nct06445972","kind":"trial","name":"Substudy 06D: Combination Therapies in Second Line (2L) Gastroesophageal Adenocarcinoma (MK-3475-06D/Keymaker-U06)","route":"/trials/nct06445972/"},{"id":"nct05096663","kind":"trial","name":"Testing the Use of Combination Immunotherapy Treatment (N-803 [ALT-803] Plus Pembrolizumab) Against the Usual Treatment for Advanced Non-small Cell Lung Cancer","route":"/trials/nct05096663/"},{"id":"nct06448754","kind":"trial","name":"Volrustomig Priming Regimens Exploratory Phase II Platform Study","route":"/trials/nct06448754/"}],"person":[{"id":"ryu-min-hee","kind":"person","name":"Min-Hee Ryu","route":"/people/ryu-min-hee/"}],"paper":[{"id":"paper-rainbow-ramucirumab-paclitaxel-lancet-oncol-2014","kind":"paper","name":"RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in previously treated advanced gastric cancer","route":"/key-papers/paper-rainbow-ramucirumab-paclitaxel-lancet-oncol-2014/"}],"drug":[{"id":"ziv-aflibercept","kind":"drug","name":"Ziv-aflibercept","route":"/drugs/ziv-aflibercept/"}]}}