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Alternative Tumor-Targeting Strategies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Developed by ImClone Systems Inc., ramucirumab (CyramzaTM) is a human monoclonal antibody that works in a related manner by binding to the extracellular binding domain of the VEGFR-2 receptor itself. This prevents the binding of ligands such as VEGF-A, VEGF-C, and VEGF-D, thus inhibiting angiogenesis pathways. In the UK it is recommended by NICE for the treatment of advanced gastric cancer or gastro-oesophageal junction adenocarcinoma, metastatic colorectal cancer, and locally advanced or metastatic non-small cell lung cancer, either as single agent or in combination with chemotherapy agents. In the US it is approved for similar indications. The side effects of ramucirumab are similar to bevacizumab and include GI disorders, cardiovascular symptoms, liver dysfunction, blood disturbances, hypoalbuminemia, peripheral edema, and rash.
Hepatocellular Carcinoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Daniel H. Palmer, Philip J. Johnson
The second trial investigated ramucirumab, a monoclonal antibody targeting VEGFR2. Subgroup analysis of an initial negative trial suggested potential benefit for ramucirumab in patients with elevated baseline serum AFP >400 ng/ml.99 This observation has been confirmed in a prospective second-line trial enrolling patients with AFP >400 ng/ml.100
Oesophageal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Nyree Griffin, Jason Dunn, Lee Alexander Grant
In 2014, ramucirumab, a monoclonal antibody targeting vascular endothelial growth factor receptor-2 (VEGFR2), was approved in the US for the treatment of gastric and gastroesophageal junction adenocarcinomas. This was based partly on the results of the RAINBOW trial, which showed a survival benefit when ramucirumab was combined with standard chemotherapy (87).
Cancer-associated fibroblasts and the tumor microenvironment in non-small cell lung cancer
Published in Expert Review of Anticancer Therapy, 2022
Jun Suzuki, Masahiro Tsuboi, Genichiro Ishii
Ramucirumab is a monoclonal antibody that binds to VEGFR2 and inhibits the angiogenic signaling cascade mainly through VEGFA/VEGFR2. It proved to be an effective treatment in a phase III study (REVEL study) comparing docetaxel plus ramucirumab and docetaxel alone in patients with advanced NSCLC, including squamous cell carcinoma, who had progression after platinum-based chemotherapy [143]. In recent years, research focused on the dynamic and complex interplay of various protein molecules involved in the biological processes of angiogenesis and anti-tumor immunity, have suggested that the combination of angiogenesis inhibitors and immunotherapies, including immune checkpoint inhibitors, is likely to have a synergistic effect on antitumor activity [85]. Our group is conducting a clinical trial to evaluate the efficacy and safety of pembrolizumab plus ramucirumab in patients with resectable stage IB-IIIA NSCLC with PD-L1 expression of 1% or more (EAST ENERGY: NCT04040361).
Safety of ramucirumab treatment in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein
Published in Expert Opinion on Drug Safety, 2022
Recent research is focused on ramucirumab-containing combination therapies. Harding et al. indicated that ramucirumab combined with emibetuzumab (LY2875358), an anti-met proto-oncogene (MET) monoclonal antibody, was well tolerated and led to a three-fold improvement in PFS in patients with advanced HCC and high MET expression [83]. Lin et al. reported the preliminary results of combination therapy using ramucirumab with 5-fluorouracil/oxaliplatin/leucovorin infusion for treatment-naïve advanced HCC; however, this regimen was associated with significant toxicity and poor tolerance [84]. A phase Ib trial investigated combination therapy using durvalumab (a PD-L1 inhibitor) and ramucirumab in refractory advanced HCC; the authors observed acceptable tolerability with a higher response in tumors that showed PD-L1 expression [85]. A phase I trial reported that combination of angiopoietin 2 inhibitor (zansecimab, or LY3127804) and ramucirumab was well-tolerated in patients with advanced solid tumors including HCC [86]. Another phase I trial reported the preliminary result of a transforming growth factor-β 1 inhibitor (galunisertib, or LY2157299) plus ramucirumab in advanced HCC but further trials were halted due to a limited efficacy [87]. Trials are underway to investigate more potential combinations, different clinical settings, and therapeutic formulations. Table 1 summarizes the results of ramucirumab-containing combination therapies and ongoing studies reported in the published literature.
Development and clinical application of bispecific antibody in the treatment of colorectal cancer
Published in Expert Review of Clinical Immunology, 2020
Maryam Balibegloo, Nima Rezaei
VEGF glycoprotein family arouses angiogenesis through tyrosine kinase receptors VEGFR-1 and VEGFR-2. The biologic activity of VEGF-A, a ligand with a principle role in angiogenesis, is inhibited by bevacizumab through prevention of its binding to VEGFR [26,92,93]. Ramucirumab is another mAb that targets VEGFR2. Both bevacizumab and Ramucirumab are approved for the treatment of mCRC when combined with 5-FU-based chemotherapy regimens [26,84,85,92]. The main side effects of bevacizumab are hypertension, thromboembolic events and hemorrhage, proteinuria and bowel perforation, while ramucirumab toxicities are mainly neutropenia, hypertension, diarrhea, and fatigue. Furthermore, combining the antiangiogenic therapies to chemotherapy will increase their cytotoxic adverse events such as nausea, vomiting, anorexia, etc. Talking about the efficacy limitations, they have demonstrated no efficacy in non-mCRC patients. Moreover, there are many other angiogenesis pathways that may be activated by anti-VEGF therapy as a compensatory mechanism. The activation of these compensatory mechanisms may result in the resistance to anti-VEGF therapy [26].