Overview
Ramucirumab is a drug used in the treatment of multiple cancers. The drug can be advised to be consumed alone or with other drugs for synergistic effects. In 2015 the drug was approved by the Food and Drug Administration for treating metastatic non-small cell lung cancer, and in 2019 it was approved to be used in combination with Erltinib. However, in 2022, the drug was approved for treating colorectal cancer in patients with a previous history of cancer treatment.
What Is Ramucirumab?
Ramucirumab is a drug specifically used in combination with other cancer drugs to treat stomach or colorectal cancer when the patient does not respond to other medications. The drug is also known to be administered with an alternative medication for treating non-small cell lung cancer.
How Does Ramucirumab Work?
The drug is a monoclonal antibody, which is helpful in treating a variety of cancers. It blocks the protein action of the vascular endothelial growth factor, which is responsible for promoting the growth of new blood vessels and supplying oxygen to cancer cells. Inhibiting the vascular endothelial growth factor receptor 2 can drastically decrease the blood supply to tumors and thereby help limit the spread. The vascular endothelial growth factor receptor 2 is usually found on the surface of endothelial cells, which lines the blood vessels. It also prevents the activation of receptors and promotes the formation of new blood vessels.
Uses:
The drug has been used in the following medical conditions:
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Colon cancer.
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Advanced gastric cancer.
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Colorectal cancer,
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Hepatocellular carcinoma.
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Metastatic breast cancer.
Dosage:
The drug dosage recommended for Ramucirumab depends on various factors like the type of cancer and individual factors like body weight and overall health of the individual. The drug is administered via intravenous infusion (injected into the vein), and this is usually done every two weeks. The dosage regimen for different cancer types is mentioned below:
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For advanced gastric or gastroesophageal cancer, the dosage is administered at 8 milligrams/kilogram body weight every two weeks.
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In non-small cell lung cancer, a dose of 10 mg/kg body weight is administered every three weeks in combination with other chemotherapeutic drugs.
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For colorectal cancer, a dosage of 8 mg/kg body weight is administered every two weeks.
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In hepatocellular carcinoma, a dosage of 8 mg/kg body weight is administered every two weeks as a single agent or may be used in combination with other drugs.
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In breast cancer, the dosage administered is 10 mg/kg body weight, which is done every three weeks.
Following the recommended dosage is crucial for optimal treatment, as the dosage varies for individual cases. Also, the doctor may alter the dosage according to the patient’s prognosis. Higher doses may be recommended in severe cases.
Warnings:
Like any other drug Ramucirumab also comes with certain limitations.
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Bleeding - The drug is known to induce bleeding, especially serious or fatal bleeding. Hence it is not recommended for patients with a history of severe bleeding and those on blood thinners, as it may cause severe side effects.
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Hypertension - The drug increases blood pressure, which can cause serious complications like stroke and heart attack. Therefore, blood pressure should be carefully monitored during the treatment.
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Gastrointestinal Perforation - The drug increases gastrointestinal perforation, which is a serious complication and may demand surgery.
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Impaired Wound Healing - The drug delays the wound healing process after surgical procedures. Hence it has to be discontinued for at least four weeks before surgery.
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In Pregnancy and Breastfeeding - The drug may harm the developing fetus, and hence sufficient precaution should be considered before proceeding with the treatment.
For Patients:
What Is Colorectal Cancer?
The colon or rectal cancer is called colorectal cancer, which affects the large intestine primarily. The cancer starts small and may develop into a polyp over time. If ignored, it could evade the nearby lymph nodes and cause serious complications. The exact cause of the cancer is yet to be known. However, a few risk factors include gene mutations and family history.
When and How Often to Take Ramucirumab?
The drug is administered in a healthcare facility like a hospital or clinic. The dosage and frequency of the drug depend on the age, weight, and type of cancer being treated. The drug is administered once in two or three weeks, and the dosage may vary between 8 to 10 mg/kg body weight. The drug is usually administered by a trained healthcare professional.
How Effective Is Ramucirumab?
The drug is effective in various types of cancer, and clinical trials have shown it to improve the survival of an individual. The drug, when combined with other chemotherapeutic drugs in cancer patients, is known to have higher response rates, rather than administering the drug alone.
In metastatic colorectal cancer, the drug has improved overall survival and progression compared to a placebo effect. However, the effectiveness is also determined by the type and stage of cancer. Understanding the potential risks and benefits helps determine the appropriate treatment for the individual.
Things to Inform The Doctor Before They Prescribe Ramucirumab:
Always inform the doctor of any allergic reactions, medical history, and drug history, as it helps with administering appropriate dosage to prevent complications.
Look Out for Side Effects:
Some of the side effects associated with the drug are mentioned below:
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Hypertension or blood pressure.
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Fatigue or weakness.
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Mouth ulcers.
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Back pain.
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Nasal congestion.
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Bleeding.
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Headaches.
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Blood clots.
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Poor wound healing.
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Perforations of the gastrointestinal tract.
Dietary Alterations:
No specific dietary alterations are recommended unless suggested by the doctor. Consuming a healthy and balanced diet would be helpful in the recovery process.
What Should Be Done When a Dose Is Missed?
Missing a dose can delay the recovery of the individual. Hence a reminder or a schedule can help the patient from missing a dose for prompt treatment and speedy recovery.
What Should Be Done to Treat Ramucirumab Overdose?
Immediate medical attention has to be sought in case of a drug overdose. The symptoms and severity of the overdose vary depending on the medication taken by the individual. No specific antidote is currently available for Ramucirumab overdose.
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Closely monitor the patient for vital signs like blood pressure and heart rate.
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In case of any emergency or allergic reactions, report to the health care professional immediately.
How to Store Ramucirumab?
In order to maintain the drug's effectiveness, Ramucirumab is refrigerated at two degree Celsius. Protecting the drug from light can help to retain maximum effectiveness. Do not freeze the drug, as it can damage the action of the drug. Avoid shaking the vial vigorously; just invert it a few times to mix the solution gently. In case of expired drugs, avoid using them and constantly check the date printed on the packaging.
How to Handle Ramucirumab?
The drug is administered by the health care professional intravenously. The dosage is decided by the severity of the disease. The drug should be diluted with sodium chloride before administration. It is recommended that 10 milligrams of the drug be diluted with 10 ml of 0.9 percent sodium chloride. It is better to avoid mixing the drug with other drugs unless recommended by the doctor. Wear gloves before handling the drug to avoid accidental pricks or spills.
How to Dispose of Ramucirumab?
Unused medications should not be disposed of in the house or environment as it may be harmful. After every use, the needles and sharp objects have to be disposed of in separate containers. Also, following standard community guidelines for medication disposal can be helpful. Always keep the drug out of reach from pets and children to avoid accidental exposure to the drug. Some medications could have harmful effects on the environment.
Avoid Self-Medication:
Self-medication can be very harmful, so it is better to avoid administering drugs without consulting the doctor, as it could cause serious side effects and consequences.
Tips to Stay On Track:
Keep track of the appointment to avoid missing the drug dose, as it could affect the rate of recovery. Do not skip the drug or overdose on the drug.
For Doctors:
Indication:
The drug is indicated in the following medical conditions
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Colorectal cancer.
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Small cell lung cancer.
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Stomach cancer.
The drug may be used with other drugs, depending on the severity of the condition.
Pharmacology of Ramucirumab:
Pharmacodynamics:
The drug binds to vascular endothelial growth factor receptors and inhibits the formation of new blood vessels, which is necessary to stop the tumor growth and its metastasis. The pharmacodynamic effect is related to angiogenesis and its inhibition. It prevents the blood flow, thereby preventing tumor growth. This improves the overall survival of the patient and other measures of cancer progression.
Ingredients:
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Active Ingredient: The active ingredient is a monoclonal antibody. It is a recombinant IG1 that binds to the vascular endothelial growth factor.
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Inactive Ingredients: The inactive ingredients include a sterile pale yellow solution that helps with intravenous infusion. No other inactive ingredients are found in Ramucirumab.
Absorption:
Once the drug is administered intravenously, it reaches the bloodstream and bypasses the digestive system. In the bloodstream, it targets specific sites and blocks the growth of tumor cells by inhibiting blood supply.
Administration of the Drug:
The drug has to be administered intravenously. The injection site is cleaned thoroughly with cotton and spirit to maintain a sterilized environment.
Considerations for Administration:
Before administering any drug, it is crucial to inquire about the patient’s medical history, family history, and drug history to avoid unwanted drug interactions.
Contraindications:
The drug has to be avoided in patients with a previous history of allergic reactions, which could range from mild to severe. The drug can increase the severe risk of bleeding and can be avoided in patients under anticoagulant therapy. Some patients have noticed delayed wound healing with drug administration; hence it is contraindicated in such cases. It can harm the fetus or child during pregnancy and breastfeeding as it may cause birth defects. Hence it is best avoided in such patients. Before prescribing the drug, a proper history of the patient can avoid unwanted complications.
Clinical Studies for Ramucirumab:
The drug has been extensively studied in various clinical trials for its effectiveness and safety in treating different types of cancer. In colorectal cancer, a phase 3 clinical trial in combination with Fluorouracil for treating gastric cancer and gastroesophageal junction showed the combination therapy had better results.
Drug Interactions:
There are higher chances of bleeding when administered with anticoagulant drugs. The drug may also influence the effect of live vaccines.
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Ramucirumab in Pregnant Women: The drug is contraindicated in pregnant women as it may cause birth defects in the developing child. Hence care should be taken to administer alternative drugs for treatment.
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Ramucirumab in Lactating Women: The use of drugs on lactating mothers is yet to be known. Hence it is not advised to breastfeed while under Ramurcirumab medication. The drug comprises large-size monoclonal antibodies, which are unlikely to pass through breast milk.
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Ramucirumab in Pediatric Patients: The drug's action on pediatric patients is not very specific and is not approved. Various clinical trials are conducted to investigate the safety of the drug, but more research may be required to arrive at a conclusion. Understanding the potential benefits and side effects of the drug is crucial before administering the drug.
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Ramucirumab in Geriatric Patients: In geriatric patients, the response rate is low, as most patients have existing comorbidities that inhibit and worsen the disease progression.
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Ramucirumab in Renal Impairment Patients: A dosage adjustment may be required in patients with renal impairment. Drug clearance is slightly decreased in renal-impaired patients, resulting in increased drug exposure. Hence it is essential to monitor renal functions regularly in patients receiving Ramucirumab.
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Ramucirumab in Hepatic Impairment Patients: Similar to renal-impaired patients, a dosage adjustment may be needed for patients with hepatic impairment. As the drug clearance is decreased, it is essential to monitor the dosage requirements of the patient.
