Ramucirumab (Specialist drug)

Dose varies by indication (US label): Gastric cancer 8 mg/kg every 2 weeks as a single agent or with weekly paclitaxel (give ramucirumab before paclitaxel). Non-small cell lung cancer with EGFR exon 19 deletions or exon 21 (L858R) substitutions 10 mg/kg every 2 weeks in combination with erlotinib. NSCLC after progression on or after platinum-based chemotherapy 10 mg/kg on Day 1 of a 21-day cycle prior to docetaxel infusion. Colorectal cancer 8 mg/kg every 2 weeks prior to FOLFIRI. Hepatocellular carcinoma 8 mg/kg every 2 weeks. Premedicate all patients before each infusion with an intravenous histamine-1 receptor antagonist (e.g. diphenhydramine hydrochloride); for patients who have had a Grade 1 or 2 infusion-related reaction, premedicate with a histamine-1 receptor antagonist, dexamethasone (or equivalent) and acetaminophen. Dose modifications for proteinuria: withhold for a first occurrence of urine protein >= 2 g/24 hours until <2 g/24 hours, then resume reduced (8 mg/kg reduced to 6 mg/kg; 10 mg/kg reduced to 8 mg/kg); on recurrence >2 g/24 hours after the first reduction, withhold then resume further reduced (6 mg/kg to 5 mg/kg; 8 mg/kg to 6 mg/kg); permanently discontinue if urine protein >3 g/24 hours or nephrotic syndrome. Reduce the infusion rate by 50% for a Grade 1 or 2 infusion-related reaction; permanently discontinue for Grade 3 or 4. Permanently discontinue for Grade 3 or 4 haemorrhage, any grade gastrointestinal perforation, any arterial thromboembolic event, any grade posterior reversible encephalopathy syndrome, or severe hypertension not controllable with antihypertensive therapy. Withhold for 28 days prior to elective surgery and resume no sooner than 2 weeks after surgery and until adequate wound healing. Paediatric: safety and effectiveness in paediatric patients have not been established (studied but not established in patients aged 1 to <17 years; effect on open tibial growth plates not adequately studied). CLINICIAN CHECK: this draft is from the US FDA prescribing information (CYRAMZA, Eli Lilly, label date 2026-06-09) — no UK SPC posology was fetched; verify against the UK SPC. The source posology section was truncated at the fetch limit part-way through the 'Preparation and Administration' subsection, so preparation/administration detail beyond dose calculation was not retrieved.