Cyramza: Uses, Dosage & Side Effects
A fully human monoclonal antibody targeting VEGFR2, used to inhibit tumour angiogenesis in advanced gastric, colorectal, lung and liver cancers
Cyramza (ramucirumab) is a fully human IgG1 monoclonal antibody that targets vascular endothelial growth factor receptor 2 (VEGFR2), a key driver of tumour angiogenesis. By blocking the blood vessel growth that tumours depend on, Cyramza helps slow cancer progression in multiple advanced malignancies. It is approved for the treatment of advanced gastric or gastro-oesophageal junction adenocarcinoma (alone or with paclitaxel), metastatic colorectal cancer (with FOLFIRI chemotherapy), advanced non-small cell lung cancer (with erlotinib as first-line for EGFR-mutant tumours, or with docetaxel after prior chemotherapy), and hepatocellular carcinoma after prior sorafenib therapy. Cyramza is administered as an intravenous infusion in a hospital or clinic setting and requires a prescription.
Quick Facts: Cyramza
Key Takeaways
- Cyramza (ramucirumab) is a monoclonal antibody that blocks VEGFR2, cutting off the blood supply tumours need to grow – it is used across four major cancer types: gastric, colorectal, lung and liver cancer.
- It is given as an intravenous infusion over approximately 60 minutes, typically every 2 weeks for gastric, colorectal and liver cancers, and every 2–3 weeks for lung cancer depending on the combination partner.
- The most important risks include arterial blood clots, gastrointestinal perforation, severe bleeding and uncontrolled hypertension – blood pressure must be monitored closely throughout treatment.
- Women of childbearing potential must use effective contraception during treatment and for at least 3 months after the last dose, as ramucirumab may harm the developing foetus.
- Cyramza should not be started within 4 weeks of planned surgery and must be permanently discontinued if serious complications such as arterial thromboembolism, gastrointestinal perforation or severe bleeding occur.
What Is Cyramza and What Is It Used For?
Cyramza contains the active substance ramucirumab, a fully human immunoglobulin G1 (IgG1) monoclonal antibody. It belongs to a class of medicines known as anti-angiogenic agents – drugs that work by preventing tumours from developing the new blood vessels they need to grow and spread. Angiogenesis, the process of forming new blood vessels from existing ones, is a hallmark of cancer biology and represents a validated therapeutic target across many solid tumour types.
The specific target of ramucirumab is vascular endothelial growth factor receptor 2 (VEGFR2), a receptor protein found on the surface of endothelial cells that line blood vessels. Under normal physiological conditions, VEGFR2 is activated by vascular endothelial growth factors (VEGF-A, VEGF-C and VEGF-D), which stimulate the endothelial cells to proliferate, migrate and form new blood vessel branches. Tumours exploit this signalling pathway by secreting large quantities of VEGF ligands, thereby hijacking the body’s normal angiogenic machinery to build the dense network of blood vessels required to sustain their rapid growth.
Ramucirumab binds with high affinity to the extracellular domain of VEGFR2, preventing the VEGF ligands from activating the receptor. This blockade shuts down the downstream signalling cascades – including the MAPK and PI3K/Akt pathways – that drive endothelial cell proliferation and survival. The result is a reduction in tumour vascularisation, which deprives cancer cells of the oxygen and nutrients they need to grow, ultimately slowing or halting tumour progression.
Cyramza is approved by the European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA), and regulatory authorities worldwide for the following indications in adults:
- Advanced gastric or gastro-oesophageal junction (GEJ) adenocarcinoma with paclitaxel: Cyramza in combination with paclitaxel is indicated for patients whose disease has progressed after prior platinum- and fluoropyrimidine-containing chemotherapy. The pivotal RAINBOW trial demonstrated a significant improvement in overall survival with ramucirumab plus paclitaxel compared with placebo plus paclitaxel (median OS 9.6 vs. 7.4 months; HR 0.81).
- Advanced gastric or GEJ adenocarcinoma as monotherapy: Cyramza as a single agent is indicated for patients whose disease has progressed after prior chemotherapy and for whom combination treatment with paclitaxel is not appropriate. The REGARD trial established ramucirumab as the first biological agent to demonstrate a survival benefit as monotherapy in advanced gastric cancer (median OS 5.2 vs. 3.8 months; HR 0.78).
- Metastatic colorectal cancer (mCRC): Cyramza in combination with FOLFIRI (5-fluorouracil, leucovorin and irinotecan) is indicated for patients whose disease has progressed on or after prior therapy with bevacizumab, oxaliplatin and a fluoropyrimidine. The RAISE trial showed a significant overall survival benefit with the addition of ramucirumab to FOLFIRI (median OS 13.3 vs. 11.7 months; HR 0.84).
- Advanced non-small cell lung cancer (NSCLC) with EGFR mutations: Cyramza in combination with erlotinib is indicated as first-line treatment for adults with metastatic NSCLC whose tumours harbour activating EGFR mutations. The RELAY trial demonstrated a significant improvement in progression-free survival with ramucirumab plus erlotinib compared with placebo plus erlotinib (median PFS 19.4 vs. 12.4 months; HR 0.59).
- Advanced NSCLC after prior chemotherapy: Cyramza in combination with docetaxel is indicated for patients with locally advanced or metastatic NSCLC whose disease has progressed after platinum-based chemotherapy. The REVEL trial showed a significant improvement in overall survival with the addition of ramucirumab to docetaxel (median OS 10.5 vs. 9.1 months; HR 0.86).
- Hepatocellular carcinoma (HCC): Cyramza as monotherapy is indicated for patients with advanced HCC who have been previously treated with sorafenib and who have an alpha-fetoprotein (AFP) level of ≥400 ng/mL. The REACH-2 trial was the first positive phase 3 trial in a biomarker-selected population in second-line HCC (median OS 8.5 vs. 7.3 months; HR 0.71).
Across all approved indications, Cyramza is used in adults whose cancer has advanced despite previous treatment, with the notable exception of the EGFR-mutant NSCLC indication where it is given as first-line therapy in combination with erlotinib. The drug is always administered in a supervised healthcare setting by trained professionals, as it requires intravenous infusion and careful monitoring for potential complications.
Cyramza belongs to the class of anti-angiogenic agents – medicines that fight cancer by targeting the blood vessels that feed tumours rather than attacking cancer cells directly. By blocking VEGFR2, ramucirumab starves the tumour of its blood supply. This approach is complementary to chemotherapy and other anticancer treatments, which is why Cyramza is most commonly used in combination with established chemotherapy regimens.
What Should You Know Before Receiving Cyramza?
Contraindications
There are specific situations in which Cyramza must not be used. Your oncologist will carefully evaluate whether treatment is appropriate for you before starting therapy.
- Hypersensitivity: Do not receive Cyramza if you are allergic to ramucirumab or any of the other ingredients in the product (histidine, histidine monohydrochloride, sodium chloride, glycine, polysorbate 80 or water for injections).
- Lung cancer near major vessels: For patients with non-small cell lung cancer, Cyramza must not be used if imaging shows that the tumour has formed a cavity (cavitation) or if it is located near major blood vessels, due to the increased risk of severe or fatal haemorrhage.
Warnings and Precautions
Cyramza can cause blood clots in the arteries (arterial thromboembolism), potentially leading to heart attack or stroke. Symptoms of a heart attack include chest pain or heaviness in the chest. Symptoms of a stroke include sudden numbness or weakness in the arm, leg or face, confusion, difficulty speaking, or sudden dizziness. If you experience any of these symptoms, seek emergency medical care immediately. Cyramza will be permanently discontinued if you develop an arterial thromboembolic event.
Before and during treatment with Cyramza, inform your doctor if any of the following apply to you:
- Bleeding risk: If you have any condition that increases your risk of bleeding, or if you take any medicines that increase bleeding risk or affect blood clotting. Your doctor will perform regular blood tests to monitor clotting function.
- Liver cancer with prior variceal bleeding: If you have hepatocellular carcinoma and have previously had bleeding from enlarged blood vessels in the oesophagus (oesophageal varices) or have portal hypertension (high blood pressure in the portal vein).
- Lung cancer with recent pulmonary haemorrhage: If you have lung cancer and have recently coughed up bright red blood, or if you regularly take non-steroidal anti-inflammatory drugs (NSAIDs) or medicines that affect blood clotting.
- Hypertension: Cyramza can increase the incidence of high blood pressure. If you already have hypertension, your doctor will ensure it is adequately controlled before starting treatment and will monitor your blood pressure throughout therapy. Anti-hypertensive medications may be started or adjusted. Treatment with Cyramza may need to be temporarily interrupted or permanently discontinued if blood pressure cannot be adequately controlled.
- Aneurysms: If you have or have ever had an aneurysm (enlargement and weakening of a blood vessel wall) or a tear in a blood vessel wall (arterial dissection), inform your doctor as Cyramza may increase this risk.
- Planned surgery or wound healing: Cyramza can increase the risk of wound healing complications. You should not receive Cyramza for at least 4 weeks before planned surgery. Your doctor will decide when treatment can be restarted after surgery. If you have a wound that heals poorly during treatment, Cyramza may be interrupted until the wound has fully healed.
- Severe liver disease (cirrhosis): If you have serious liver disease with associated complications such as significant ascites (fluid accumulation in the abdomen), your doctor will carefully weigh the potential benefits against the risks. For patients with hepatocellular carcinoma, your doctor will monitor for signs of hepatic encephalopathy (confusion or disorientation related to liver dysfunction) and will discontinue Cyramza if these develop.
- Severe kidney problems: Limited data are available on the use of Cyramza in patients with severely impaired kidney function.
Tell your doctor or nurse immediately if you experience any of the following during or after treatment with Cyramza:
- Gastrointestinal perforation: Cyramza can increase the risk of developing a hole in the stomach or bowel wall. Symptoms include severe abdominal pain, vomiting, fever or chills. Treatment will be permanently discontinued.
- Severe bleeding: Symptoms may include extreme tiredness, weakness, dizziness, or a change in the colour of your stool. Treatment will be permanently discontinued.
- Infusion-related reactions: These may occur during the infusion and can include muscle stiffness, back pain, chest pain or tightness, chills, flushing, breathing difficulties, wheezing, and tingling or numbness in the hands or feet. In severe cases, symptoms may include shortness of breath from narrowed airways, rapid heartbeat, and feeling faint. Treatment will be permanently discontinued if a severe reaction occurs.
- Posterior reversible encephalopathy syndrome (PRES): A rare but serious brain condition characterised by seizures, headache, nausea, vomiting, blindness, or reduced consciousness, with or without high blood pressure. Treatment will be discontinued if PRES develops.
- Heart failure: When Cyramza is given with chemotherapy or erlotinib, there may be an increased risk of heart failure. Symptoms include weakness, tiredness, swelling, and fluid accumulation in the lungs causing breathlessness.
- Fistula: Cyramza can increase the risk of abnormal tube-like connections between internal organs and skin or other tissues. Treatment will be permanently discontinued.
- Proteinuria: Cyramza can cause or worsen abnormal protein levels in the urine. Treatment may be temporarily interrupted and resumed at a reduced dose, or permanently discontinued if protein levels remain excessively high or nephrotic syndrome develops.
- Stomatitis: When combined with chemotherapy, there may be an increased risk of mouth inflammation. Symptoms include burning sensation, sores, blisters, or swelling in the mouth.
- Fever or infection: You may develop a temperature of 38°C or higher during treatment, as you may have fewer white blood cells than normal (a very common side effect). Symptoms may include sweating, headache, pain in the limbs, or decreased appetite. Infections (sepsis) can be serious and potentially fatal.
Pregnancy and Breastfeeding
Cyramza should not be used during pregnancy. Because ramucirumab inhibits angiogenesis – the formation of new blood vessels – it may reduce the likelihood of becoming pregnant, interfere with maintenance of the pregnancy, or harm the developing foetus. Women of childbearing potential should use effective contraception during treatment and for at least 3 months after the last dose of Cyramza. Talk to your doctor about which contraceptive method is most suitable for you.
If you become pregnant while receiving Cyramza, your doctor will discuss whether the benefits of continued treatment outweigh the potential risks to you and the unborn child. You should inform your doctor immediately if you are pregnant, think you may be pregnant, or plan to become pregnant.
It is not known whether ramucirumab passes into breast milk or could affect a breastfed infant. You should not breastfeed during treatment with Cyramza and for at least 3 months after the last dose.
Children and Adolescents
Cyramza should not be given to patients under 18 years of age. There is insufficient information on how ramucirumab works in this age group, and its safety and efficacy have not been established in paediatric patients.
Driving and Operating Machinery
Cyramza has no or negligible direct effect on the ability to drive or use machines. However, if you experience any symptoms that affect your ability to concentrate and react – such as fatigue, dizziness, or headache – do not drive or operate machinery until these effects subside.
Important Information About Ingredients
Each 10 mL vial of Cyramza contains less than 1 mmol sodium (23 mg), meaning it is essentially sodium-free. However, each 50 mL vial contains approximately 85 mg of sodium (the main component of table salt), corresponding to approximately 4% of the WHO-recommended maximum daily dietary sodium intake for adults. This should be considered if you are on a sodium-restricted diet.
Cyramza also contains polysorbate 80 (approximately 1 mg per 10 mL vial and 5 mg per 50 mL vial). Polysorbates can cause allergic reactions in some individuals. Inform your doctor if you have any known allergies to polysorbate.
How Does Cyramza Interact with Other Drugs?
Tell your doctor about all medicines you are currently taking, have recently taken, or might take, including over-the-counter products and herbal supplements. Although no formal pharmacokinetic drug-drug interaction studies have been conducted with ramucirumab, the co-administration of Cyramza with chemotherapy agents and other targeted therapies requires careful attention to cumulative toxicities, particularly regarding haematological effects and bleeding risk.
Major Interactions and Combination Considerations
| Interacting Drug / Class | Effect | Clinical Significance |
|---|---|---|
| Anticoagulants (warfarin, heparin, DOACs) | Increased risk of bleeding due to additive effects on haemostasis | Monitor closely; perform regular coagulation tests and bleeding assessments |
| NSAIDs (ibuprofen, naproxen, aspirin) | Increased risk of gastrointestinal bleeding and perforation | Use with caution, especially in lung cancer patients; consider alternative analgesics |
| Antihypertensive agents | Cyramza causes hypertension; antihypertensives may need dose adjustments | Monitor blood pressure closely; adjust antihypertensive therapy as needed |
| Other anti-angiogenic agents (bevacizumab, aflibercept) | Additive anti-angiogenic toxicity (hypertension, proteinuria, bleeding, perforation) | Not recommended in combination; sequential use only |
Approved Combination Partners
| Combination Partner | Indication | Key Monitoring |
|---|---|---|
| Paclitaxel | Advanced gastric / GEJ adenocarcinoma | Blood counts (neutropenia), peripheral neuropathy, liver function |
| FOLFIRI (5-FU, leucovorin, irinotecan) | Metastatic colorectal cancer | Blood counts, diarrhoea, stomatitis, liver function |
| Erlotinib | EGFR-mutant advanced NSCLC (first-line) | Skin rash, diarrhoea, liver function, interstitial lung disease |
| Docetaxel | Advanced NSCLC (after prior chemotherapy) | Blood counts (febrile neutropenia), peripheral neuropathy, fluid retention |
When receiving Cyramza in combination with any of these agents, the safety profiles and potential interactions of all drugs in the regimen must be considered. Always consult the patient information leaflets for each combination partner. Your oncologist will carefully plan your treatment to minimise the risk of cumulative toxicities.
What Is the Correct Dosage of Cyramza?
Cyramza is always administered by a doctor or nurse as an intravenous infusion over approximately 60 minutes. The dose is calculated individually based on your body weight. Your doctor will determine the appropriate dosing schedule and duration based on your specific cancer type, treatment regimen and clinical response. The number of infusions you receive depends on how well you respond to treatment and whether you experience significant side effects.
Gastric and Gastro-Oesophageal Junction Cancer
Cyramza + Paclitaxel
Dose: 8 mg/kg intravenously on Days 1 and 15 of each 28-day cycle
Paclitaxel: 80 mg/m² on Days 1, 8 and 15 of each 28-day cycle
Duration: Continue until disease progression or unacceptable toxicity
Before each paclitaxel infusion, blood tests are required to confirm adequate blood counts and liver function.
Cyramza Monotherapy
Dose: 8 mg/kg intravenously every 2 weeks
Duration: Continue until disease progression or unacceptable toxicity
Used when combination with paclitaxel is not appropriate.
Metastatic Colorectal Cancer
Cyramza + FOLFIRI
Dose: 8 mg/kg intravenously every 2 weeks, given before the FOLFIRI infusion
Duration: Continue until disease progression or unacceptable toxicity
Refer to the prescribing information for each FOLFIRI component (5-fluorouracil, leucovorin, irinotecan) for additional guidance.
Non-Small Cell Lung Cancer
Cyramza + Erlotinib (First-Line EGFR-Mutant NSCLC)
Dose: 10 mg/kg intravenously every 2 weeks
Erlotinib: 150 mg orally once daily
Duration: Continue until disease progression or unacceptable toxicity
Cyramza + Docetaxel (After Prior Chemotherapy)
Dose: 10 mg/kg intravenously on Day 1 of each 21-day cycle
Docetaxel: 75 mg/m² on Day 1 of each 21-day cycle
Duration: Continue until disease progression or unacceptable toxicity
Patients of East Asian descent may receive a reduced starting dose of docetaxel (60 mg/m²).
Hepatocellular Carcinoma
Cyramza Monotherapy
Dose: 8 mg/kg intravenously every 2 weeks
Duration: Continue until disease progression or unacceptable toxicity
Indicated only for patients previously treated with sorafenib who have an alpha-fetoprotein (AFP) level ≥400 ng/mL.
Pre-Medication
You may receive other medicines before your Cyramza infusion to reduce the risk of infusion-related reactions. These may include an antihistamine, paracetamol (acetaminophen), and/or a corticosteroid. If you experience an infusion-related reaction during treatment, you will receive pre-medication before all subsequent infusions.
Dose Adjustments and Treatment Interruptions
Your doctor may need to modify your treatment in the following situations:
- Infusion-related reactions: If you experience a reaction during the infusion, the remainder of the current infusion and all subsequent infusions will be given over a longer time period.
- Hypertension: Treatment may be temporarily interrupted until blood pressure is controlled with medication.
- Proteinuria: Treatment may be temporarily interrupted until protein levels in the urine decrease. It may then be resumed at a reduced dose. If protein levels do not decrease sufficiently, treatment will be permanently discontinued.
- Wound healing: Treatment is interrupted if wound healing complications occur, and only resumed once the wound has fully healed.
- Planned surgery: Cyramza should not be given for at least 4 weeks before planned surgery.
Treatment with Cyramza will be permanently discontinued if you experience: an arterial thromboembolic event (blood clot in an artery), gastrointestinal perforation (hole in the bowel wall), severe bleeding, a severe infusion-related reaction, uncontrollable hypertension despite adequate medication, nephrotic syndrome or clinically significant proteinuria that does not resolve, a fistula, or hepatic encephalopathy (confusion/disorientation associated with liver disease) in HCC patients.
How Cyramza Is Given
Cyramza is a concentrate for solution for infusion (also called a “sterile concentrate”). Before administration, your hospital pharmacy, nurse, or doctor will dilute the concentrate from the vial with sodium chloride 9 mg/mL (0.9%) solution. The prepared infusion is given intravenously through a drip over approximately 60 minutes using an infusion pump with a 0.22-micrometre protein-sparing in-line filter.
Do not shake the infusion solution. Do not administer it as an intravenous push or bolus injection. The infusion line is flushed with sodium chloride 0.9% solution after the infusion is complete. Each vial is for single use only.
Cyramza is always prepared and administered by trained healthcare professionals in a hospital or specialised clinic setting. You will not self-administer this medication at home. Each infusion is carefully calculated based on your body weight and clinical condition, and you will be monitored throughout for potential infusion-related reactions.
What Are the Side Effects of Cyramza?
Like all medicines, Cyramza can cause side effects, although not everyone experiences them. The side effect profile varies depending on whether Cyramza is given as monotherapy or in combination with chemotherapy, and may differ across the various cancer types for which it is approved. Your medical team will monitor you closely and manage side effects as they arise.
Serious Side Effects Requiring Immediate Medical Attention
Tell your doctor immediately if you experience any of the following, as they may require urgent medical intervention:
Common Serious Side Effects
May affect up to 1 in 10 people
- Gastrointestinal perforation – a hole in the stomach or intestine (severe abdominal pain, vomiting, fever, chills)
- Severe intestinal bleeding (extreme tiredness, weakness, dizziness, change in stool colour)
- Arterial blood clots leading to heart attack or stroke (chest pain, sudden numbness, confusion, difficulty speaking)
Rare Serious Side Effects
May affect up to 1 in 1,000 people
- Posterior reversible encephalopathy syndrome (PRES) – seizures, headache, nausea, vomiting, blindness, reduced consciousness
General Side Effects by Frequency
Very Common
May affect more than 1 in 10 people
- Fatigue and weakness
- Decreased white blood cell count (neutropenia) – increases infection risk
- Infections
- Diarrhoea
- Hair loss (alopecia)
- Nosebleeds (epistaxis)
- Mouth inflammation (stomatitis)
- High blood pressure (hypertension)
- Low red blood cells (anaemia) causing pale skin
- Swelling of hands, feet and legs (peripheral oedema)
- Low platelet count (thrombocytopenia)
- Abdominal pain
- Protein in the urine (proteinuria)
- Headache
- Mucosal inflammation (mucositis)
Common
May affect up to 1 in 10 people
- Febrile neutropenia (fever with low white blood cells)
- Low albumin levels (hypoalbuminaemia)
- Infusion-related reactions (rash, chills, flushing, breathing difficulty)
- Skin rash
- Hand-foot syndrome (redness, swelling, numbness, peeling of palms/soles)
- Hoarseness (dysphonia)
- Pulmonary haemorrhage (bleeding in the lungs)
- Low sodium levels (hyponatraemia)
- Bleeding gums
- Confusion or disorientation in patients with chronic liver disease
- Intestinal obstruction (constipation, abdominal pain)
- Underactive thyroid (hypothyroidism)
- Abnormal blood vessel growth
- Severe infection / sepsis
- Low potassium levels (hypokalaemia)
Uncommon
May affect up to 1 in 100 people
- Heart failure (breathlessness, leg swelling)
Rare
May affect up to 1 in 1,000 people
- Thrombotic microangiopathy (abnormal blood clotting in small vessels)
Not Known
Frequency cannot be estimated from available data
- Aneurysms and arterial dissections (enlargement, weakening or rupture of a blood vessel wall)
Laboratory Abnormalities
Cyramza can cause changes in laboratory test results. From the side effects listed above, these include: low white blood cell count, low platelet count, low albumin levels, low sodium and potassium levels, and the presence of protein in the urine. Your doctor will perform regular blood and urine tests to monitor for these changes throughout your treatment.
If you are an older adult with lung cancer, your doctor will carefully evaluate the most appropriate treatment for you. Elderly patients may be at higher risk for certain side effects, and treatment decisions should take individual risk factors into account.
If you experience any side effects, including those not listed here, tell your doctor or nurse. You can also report suspected side effects to your national pharmacovigilance authority (e.g., the EMA in Europe, the FDA MedWatch programme in the United States, or the MHRA Yellow Card Scheme in the United Kingdom) to help monitor the ongoing benefit-risk profile of Cyramza.
How Should Cyramza Be Stored?
Keep this medicine out of the sight and reach of children. Do not use after the expiry date stated on the outer carton and vial label after “EXP”. The expiry date refers to the last day of that month.
- Unopened vials: Store in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze.
- Light protection: Keep the vial in the outer carton to protect from light.
- Prepared infusion solution: Must not be frozen or shaken. Should be used immediately. If not used immediately, the chemical and physical in-use stability has been demonstrated for up to 24 hours at 2°C to 8°C.
- Inspection: Do not administer the solution if you notice particles or discolouration. The concentrate should be clear to slightly opalescent and colourless to slightly yellow.
As Cyramza is prepared and administered in a hospital or clinic, storage will be handled by your healthcare team and pharmacy. Do not dispose of any medicines via wastewater or household waste. Ask your pharmacist how to properly dispose of medicines that are no longer needed. These measures help protect the environment.
What Does Cyramza Contain?
Active Substance
The active substance is ramucirumab. Each millilitre of the sterile concentrate for solution for infusion contains 10 mg of ramucirumab.
- One 10 mL vial contains 100 mg of ramucirumab
- One 50 mL vial contains 500 mg of ramucirumab
Inactive Ingredients (Excipients)
- Histidine
- Histidine monohydrochloride
- Sodium chloride
- Glycine (E640)
- Polysorbate 80 (E433)
- Water for injections
Appearance and Pack Sizes
The concentrate for solution for infusion is a clear to slightly opalescent and colourless to slightly yellowish solution supplied in a glass vial with a rubber stopper. Cyramza is available in the following pack sizes:
- 1 vial of 10 mL (100 mg ramucirumab)
- 2 vials of 10 mL (200 mg ramucirumab total)
- 1 vial of 50 mL (500 mg ramucirumab)
Not all pack sizes may be marketed in every country.
Manufacturer
Cyramza is manufactured and marketed by Eli Lilly. The marketing authorisation holder is Eli Lilly Nederland B.V., Utrecht, the Netherlands. The manufacturing site is Lilly France, Fegersheim, France.
Frequently Asked Questions About Cyramza
Cyramza (ramucirumab) is used to treat several types of advanced cancer in adults. It is approved for advanced gastric or gastro-oesophageal junction adenocarcinoma (alone or with paclitaxel after prior chemotherapy), metastatic colorectal cancer (with FOLFIRI after prior treatment), advanced non-small cell lung cancer with EGFR mutations (with erlotinib as first-line treatment), advanced NSCLC after prior chemotherapy (with docetaxel), and hepatocellular carcinoma (liver cancer) in patients previously treated with sorafenib who have elevated alpha-fetoprotein levels.
Cyramza works by blocking vascular endothelial growth factor receptor 2 (VEGFR2), a protein on blood vessel cells that tumours use to grow new blood vessels (a process called angiogenesis). Tumours need new blood vessels to receive oxygen and nutrients for growth. By blocking VEGFR2, ramucirumab prevents the growth factors VEGF-A, VEGF-C and VEGF-D from stimulating new blood vessel formation, effectively starving the tumour of its blood supply and slowing cancer progression.
Cyramza is given as an intravenous infusion (drip) over approximately 60 minutes in a hospital or clinic by a healthcare professional. For gastric cancer, colorectal cancer and liver cancer, the dose is 8 mg/kg every 2 weeks. For lung cancer, the dose is 10 mg/kg every 2 weeks (with erlotinib) or every 3 weeks (with docetaxel). Treatment continues until the cancer progresses or side effects become unacceptable. Your doctor will monitor you during and after each infusion.
Yes, hypertension (high blood pressure) is a very common side effect of Cyramza, affecting more than 1 in 10 patients. This is a class effect shared by all anti-angiogenic drugs. Your doctor will check that your blood pressure is well controlled before starting treatment and will monitor it regularly during therapy. If your blood pressure rises significantly, your antihypertensive medications may be adjusted, and Cyramza may need to be temporarily suspended until blood pressure is under control. In rare cases where blood pressure cannot be adequately managed, treatment may be permanently discontinued.
You should not receive Cyramza for at least 4 weeks before any planned surgery, as it can impair wound healing. If you have a wound that is not healing well during treatment, Cyramza will be paused until the wound is fully healed. After surgery, your doctor will determine when it is safe to restart treatment. If you have an emergency surgery, inform the surgical team that you are receiving Cyramza, as this may affect their management of wound healing and bleeding risk.
No, although both are anti-angiogenic monoclonal antibodies, they work differently. Bevacizumab (Avastin) binds to the VEGF-A growth factor itself, preventing it from reaching its receptors. Cyramza (ramucirumab) binds directly to the VEGFR2 receptor, blocking all VEGF ligands (VEGF-A, VEGF-C and VEGF-D) from activating it. They are used for different indications and in different clinical settings. Cyramza and bevacizumab should not be used together, as the combination would cause additive anti-angiogenic toxicity.
References
- European Medicines Agency (EMA). Cyramza (ramucirumab) – Summary of Product Characteristics. Last updated 2026. Available from: EMA EPAR.
- U.S. Food and Drug Administration (FDA). Cyramza (ramucirumab) Prescribing Information. Revised 2025. Available from: FDA Drug Label.
- Wilke H, Muro K, Van Cutsem E, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014;15(11):1224–1235. doi:10.1016/S1470-2045(14)70420-6.
- Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014;383(9911):31–39. doi:10.1016/S0140-6736(13)61719-5.
- Tabernero J, Yoshino T, Cohn AL, et al. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015;16(5):499–508. doi:10.1016/S1470-2045(15)70127-0.
- Nakagawa K, Garon EB, Seto T, et al. Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated, advanced non-small-cell lung cancer (RELAY): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(12):1655–1669. doi:10.1016/S1470-2045(19)30634-5.
- Garon EB, Ciuleanu TE, Arrieta O, et al. Ramucirumab plus docetaxel versus placebo plus docetaxel for second-line treatment of stage IV non-small-cell lung cancer after disease progression on platinum-based therapy (REVEL): a multicentre, double-blind, randomised phase 3 trial. Lancet. 2014;384(9944):665–673. doi:10.1016/S0140-6736(14)60845-X.
- Zhu AX, Kang YK, Yen CJ, et al. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased α-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(2):282–296. doi:10.1016/S1470-2045(18)30937-9.
- Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159–182.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians with expertise in oncology, gastroenterology, hepatology and clinical pharmacology.
Medical Content
iMedic Oncology Editorial Team – specialist physicians in medical oncology with clinical experience in gastrointestinal and thoracic cancers
Medical Review
iMedic Medical Review Board – independent panel verifying accuracy against EMA SmPC, FDA label, NCCN, and ESMO guidelines
Pharmacology Review
iMedic Clinical Pharmacology Team – specialists in anti-angiogenic therapies, drug interactions, and medication safety
Accessibility & SEO
iMedic Digital Health Team – ensuring WCAG 2.2 AAA compliance and optimal search visibility
All content follows the GRADE evidence framework and is reviewed according to international medical guidelines. iMedic receives no commercial funding from pharmaceutical companies.