Ramucirumab

Ramucirumab, sold as Cyramza, is an antibody drug that blocks VEGFR-2, a receptor tumors use to grow new blood vessels. In the Italian RAMES trial, adding it to gemcitabine chemotherapy lengthened survival in people whose mesothelioma had grown after first treatment, but it is not approved for mesothelioma in the United States.

Origin

Ramucirumab was developed by ImClone Systems and Eli Lilly and approved in the United States in 2014 for advanced stomach cancer, then for lung, colorectal and liver cancers. The RAMES trial, a randomized phase 2 study in Italy, compared gemcitabine with ramucirumab or placebo as second-line treatment for mesothelioma and was published in 2021.

Significance in Asbestos Context

Treatment choices after first-line therapy for mesothelioma are limited, and RAMES was one of the few randomized trials to show longer overall survival in that setting. Because it was a phase 2 trial in one country, it has not led to regulatory approval, and guidelines and oncologists differ in how they use it; insurance coverage for this off-label use may need prior authorization. Ramucirumab works differently from bevacizumab, which blocks the growth signal VEGF itself; ramucirumab blocks the receptor. Side effects include high blood pressure, bleeding, slower wound healing and, rarely, a hole in the bowel, so doctors check blood pressure and urine protein during treatment. In lung cancer, ramucirumab is approved with docetaxel after earlier treatment. For families, it is a name likely to come up when first-line treatment stops working.

Example Sentence

When his mesothelioma progressed after immunotherapy, his oncologist proposed gemcitabine with ramucirumab, citing the RAMES trial, and asked his insurer for prior authorization.

Related Terms

VEGF Inhibitors, Angiogenesis, Bevacizumab, Monoclonal Antibody, Chemotherapy, Clinical Trial, Overall Survival, Disease Progression

Notes

• If an insurer denies an off-label drug, ask the oncology office about an appeal; they often handle these.
• Keep a blood pressure log at home if your team asks for one.
• Ask whether a clinical trial is open to you before or alongside second-line treatment.