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Cyramza ® (ramucirumab) injection
10 mg/mL solution
This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.
What are the recommended dosing regimens for Cyramza® (ramucirumab)?
Cyramza (ramucirumab) is dosed based on indication.
Approved Dosing Regimens
It is recommended that treatment with ramucirumab be continued until progression of the underlying disease or until unacceptable toxicity.1
Gastric Cancer
Single Agent
The recommended dose of ramucirumab as a single agent is 8 mg/kg every 2 weeks administered as an intravenous (IV) infusion over 60 minutes.1
In Combination With Paclitaxel
The recommended dose of ramucirumab is 8 mg/kg every 2 weeks administered as an IV infusion over 60 minutes prior to administration of paclitaxel.1
Non-Small Cell Lung Cancer
In Combination with Docetaxel
The recommended dose of ramucirumab is 10 mg/kg administered by IV infusion over 60 minutes on day 1 of a 21-day cycle prior to docetaxel infusion.1
In Combination with Erlotinib
The recommended dose of ramucirumab is 10 mg/kg every two weeks administered by IV infusion over 60 minutes.1
Colorectal Cancer
The recommended dose of ramucirumab is 8 mg/kg every 2 weeks administered by IV infusion over 60 minutes prior to irinotecan, folinic acid and 5-fluorouracil (FOLFIRI) administration.1
Hepatocellular Carcinoma
The recommended dose of ramucirumab is 8 mg/kg every 2 weeks administered by IV infusion over 60 minutes.1
Shorter Duration of Infusion
The ramucirumab prescribing information recommends that if the first 60-minute infusion of ramucirumab is tolerated, then all subsequent infusions may be administered over 30 minutes. This applies to all recommended doses of ramucirumab and all approved indications.1
Premedication
Prior to each ramucirumab infusion, all patients should be premedicated with an IV histamine-1 receptor antagonist (eg, diphenhydramine hydrochloride).1
Patients who have experienced a grade 1 or 2 infusion-related reaction, should be premedicated prior to each ramucirumab infusion with the following
- a histamine-1 receptor antagonist
- dexamethasone (or equivalent), and
- acetaminophen.1
Dose Modifications
The recommended dose adjustments for ramucirumab are summarized in . For toxicities related to paclitaxel, docetaxel, erlotinib, or the components of FOLFIRI, please refer to the current prescribing information for these products.
Adverse Reaction |
Severitya |
Recommended Dose Modification |
IRRs |
Grade 1 or 2 |
Reduce the infusion rate of ramucirumab by 50%. |
Grade 3 or 4 |
Permanently discontinue ramucirumab. |
|
Hypertension |
Severe hypertension |
Withhold ramucirumab until controlled with medical management. |
Severe hypertension that cannot be controlled with antihypertensive therapy |
Permanently discontinue ramucirumab. |
|
Proteinuria |
First occurrence of increased urine protein levels ≥2 g/24 hours |
Withhold ramucirumab until urine protein level is <2 g/24 hours. When resuming treatment, reduce the dose to
|
Reoccurrence of urine protein level >2 g/24 hours following initial dose reduction |
Withhold ramucirumab until urine protein level is <2 g/24 hours. When resuming treatment, further reduce the dose to
|
|
Urine protein level >3 g/24 hours or in the setting of nephrotic syndrome |
Permanently discontinue ramucirumab. |
|
Wound-healing complications |
All grades |
Withhold ramucirumab for 28 days prior to elective surgery. Do not administer ramucirumab for at least 2 weeks following surgery and until adequate wound healing. The safety of resumption of ramucirumab after resolution of wound healing complications has not been established. |
ATE, GI perforation, PRES |
All grades |
Permanently discontinue ramucirumab. |
Hemorrhage |
Grade 3 or 4 |
Abbreviations: ATE = arterial thromboembolic event; GI = gastrointestinal; IRR = infusion-related reaction; PRES = posterior reversible encephalopathy syndrome.
aNational Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE) Criteria Version 4.0 used to identify adverse reactions.
Enclosed Prescribing Information
Reference
1Cyramza [package insert]. Indianapolis, IN: Eli Lilly and Company; 2022.
Date of Last Review: May 17, 2022