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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.
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.
Backbone ribbon from PDB 3S37. RCSB PDB 3S37. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Fully human IgG1 binding VEGFR2 ectodomain, blocking VEGF-A/C/D signalling. Connects to VEGF / VEGFR.
1.Ramucirumab binds VEGF / VEGFR.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies.
Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments.
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE TA378. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
| Region | Year | Indication |
|---|---|---|
| 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 · TA403, published 24 August 2016, does not recommend ramucirumab with docetaxel within its marketing authorisation. |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Hypertension | 25% | 13% |
| Proteinuria | 20% | 2% |
REACH-2. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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Query for this drug: (TITLE:"Ramucirumab" OR ABSTRACT:"Ramucirumab" OR TITLE:"Cyramza" OR ABSTRACT:"Cyramza") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Ramucirumab, not a curated reading list.
Shares Min-Hee Ryu, Claudin 18.2-positive gastric cancer, Gastric cancer (KEGG map), PD-L1-high gastric cancer.
Shares RAISE, Ziv-aflibercept, VEGF / VEGFR, Anti-angiogenic therapy.
Shares CLARITY-Gastric 01, Min-Hee Ryu, Claudin 18.2-positive gastric cancer, Gastric cancer (KEGG map).
Shares Lung cancer: the failed and stopped programmes, and why, Squamous cell carcinoma of the lung, Eli Lilly (incl. Loxo), Monoclonal antibodies.
Shares Lung cancer drugs in England: what NICE has recommended, The angiogenic switch & tumour vessels, VEGF / VEGFR, Anti-angiogenic therapy.
Shares REVEL, VEGF / VEGFR, Anti-angiogenic therapy, Lung cancer (all types).
Shares Hepatocellular carcinoma (KEGG map), Oesophageal and junctional adenocarcinoma, Oesophageal cancer, Hepatocellular carcinoma.
Shares Hepatocellular carcinoma (KEGG map), VEGF angiogenesis, VEGF / VEGFR, Anti-angiogenic therapy.