ramucirumab
Meaning of ramucirumab: An approved antibody that starves tumors of new blood vessels by occupying the receptor rather than the growth signal itself.
Definition of ramucirumab
Ramucirumab is a laboratory made antibody used to treat several advanced cancers, among them stomach, lung, bowel and liver cancer. It attaches to VEGF receptor 2 on the cells lining blood vessels and stops the growth signal reaching them, so a tumor struggles to build the new vessels it needs. It is given as an infusion into a vein.
How does it work?
A tumor larger than a pinhead needs its own blood supply, so it releases vascular endothelial growth factor, known as VEGF, to recruit new vessels. VEGF works by attaching to receptors on the cells that line vessels, chiefly VEGF receptor 2. Ramucirumab is an antibody shaped to occupy that receptor, so the growth signal cannot dock there. New vessel formation slows, abnormal vessels regress, and the tumor's supply lines are squeezed. Blocking the receptor rather than mopping up the circulating growth factor is what separates it from bevacizumab.
Where is it used?
| Cancer | Setting |
|---|---|
| Stomach and the junction with the esophagus | Advanced disease after earlier chemotherapy, alone or with a chemotherapy drug |
| Non small cell lung cancer | With chemotherapy, and with a targeted drug in tumors carrying certain EGFR changes |
| Colorectal cancer | With chemotherapy after progression on earlier treatment |
| Liver cancer | Where alpha-fetoprotein in the blood is raised, after earlier treatment |
Trials in breast cancer did not show a benefit, and the drug is not used for that disease despite having been studied in it.
What kind of drug is it?
It is a monoclonal antibody, meaning every molecule is identical and aimed at a single target, and it is fully human in sequence, which lowers the chance of the immune system reacting against it. Being a large protein, it cannot be swallowed, since digestion would destroy it, so it is infused. As an antiangiogenesis agent it does not kill cancer cells directly. It acts on the tumor's surroundings, which is why it is usually combined with chemotherapy rather than used in place of it.
What are its characteristic effects?
The side effects follow from the mechanism, because normal blood vessels depend on the same signal. Raised blood pressure is the most frequent, and it is monitored throughout treatment. Bleeding, poor wound healing and holes forming in the bowel wall are less common but serious, which is why treatment is generally paused around surgery. Protein leaking into the urine reflects the effect on the fine vessels of the kidney. Reactions during the infusion itself occur and are handled by slowing or stopping it.
Also known as
Used in a sentence
Ramucirumab was added to chemotherapy for advanced gastric cancer after disease progression.
Good to know
Ramucirumab is an approved treatment for several advanced cancers rather than an investigational compound, and because it blocks a signal that healthy vessels also use, raised blood pressure, impaired wound healing and bleeding are recognized effects.