This leaflet provides information on a treatment known as Ramucirumab. It will explain what this is and when and how it will be given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on this treatment are given at the end of the leaflet.
What is Ramucirumab.
Ramucirumab is an antibody which attaches itself to cancer cells and stops them from growing. It is not chemotherapy. It works by blocking receptors, which prevents the cancer from dividing as well as making new blood vessels. This reduces the supply of oxygen and nutrients to the tumour, so it stops growing or shrinks.
Why am I having this treatment?
Your doctor has prescribed this treatment because it is believed to be effective in treating your type of cancer.
How often will I receive this treatment?
For this treatment to be most effective it will be given at specific time intervals. These are known as cycles. Your doctor will discuss the number of cycles you will receive, and the time intervals between the cycles. It is usually given with your chemotherapy on day 1 and day 15 of a 28 day cycle.
How will my treatment be given?
Your treatment is given through a drip into a vein in the back of your hand or arm. If needed, it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This line can remain in place for the whole of your treatment. Your doctor or nurse will explain this in more detail, if required.
We have a leaflet that tells you more about PICC lines, if needed.
How long will I be in hospital?
The Ramucirumab is administered on day 1 and 15 of the 28 day cycle. It will be administered on the same day as the Taxol/ Paclitaxel chemotherapy. The Taxol may take approximately 3 hours to administer, in addition the Ramucirumab will take approximately 1 hr to administer. You should allow up to 5 hours on days 1 and 15 of the cycle. On day 8 – Taxol alone will given, which should take approximately 3 hours.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
How often will I see the specialist team?
You will usually see the specialist team every 28 days. However, your team will let you know how often they will see you. You will have regular blood tests and we will check how you are feeling and discuss any problems you may have. This is so we can check how the treatment is affecting you.
What are the possible side effects?
This type of treatment is usually very well tolerated and most patients don’t have many side effects. The doctor, nurses and pharmacists can give you advice or answer any questions you may have.
This treatment should not cause hair loss.
Ramucirumab alone does not usually cause sickness.
Tiredness and fatigue
This treatment may make you feel more tired than usual. It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
High blood pressure
Ramucirumab can cause an increase in blood pressure in some people. Your blood pressure will be checked regularly during your treatment. If you have headaches, nosebleeds or feel dizzy let your doctor know. High blood pressure can usually be controlled with tablets prescribed by your doctor.
Protein in the urine
This can occur due to effects of Ramucirumab on the kidneys. It doesn’t normally cause symptoms but requires careful monitoring. Before each dose of treatment you will have your urine tested for protein. If protein is identified you may need to have a 24-hour urine collection to assess how well your kidneys are working. Ramucirumab may be stopped until the protein found in the urine has resolved.
Ramucirumab may cause bleeding problems. Tell your doctor if you take any medicines that may affect bleeding, such as aspirin, warfarin or vitamin E. If you vomit coffee ground vomit, pass black motions at any time, have any abdominal pain, or if you notice excessive bruising or bleeding, for example nose bleeds, ring the chemopager, the telephone number is at the end of the leaflet.
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or below 35.5°centigrade. The telephone number is at the end of this leaflet.
Your mouth may become sore or you may notice small ulcers. Please follow the advice on caring for your mouth in the general chemotherapy leaflet. Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.
Ramucirumab can cause diarrhoea. If you experience diarrhoea, it is important to drink plenty fluids, and to ring the chemotherapy pager, especially if you have 4 or more episodes in 24 hours, the telephone number is at the end of the leaflet
Allergic type reactions
A small number of patients have an allergic type reaction to Ramucirumab. If this occurs it will be whilst Ramucirumab is infusing or immediately afterwards. Symptoms include feeling:
This can be easily treated. Please tell your nurse if you experience any of these symptoms.
Slow wound healing
Wounds may take longer to heal while you are having treatment with Ramucirumab.
A small number of patients can develop a small hole in the wall of the bowel (perforation). This is rare, but if you develop any abdominal pain or swelling contact Velindre Cancer Centre for advice.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information
Other side effects and information
You are at risk of blood clots whilst on this treatment, if you notice any shortness of breath or swollen legs, please ring the chemotherapy pager, the telephone number is at the end of the leaflet.
Sometimes patients can have swollen ankles or limbs with the treatment , if this occurs inform your specialist team.
It is important you do not become pregnant or father a child whilst having this treatment as it could damage the unborn baby. It is important to use contraception.
It is not advisable to breast feed whilst having this treatment, and for a minimum of 3 months afterwards.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night.
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus freephone 0808 808 1010
cancer support line
Macmillan freephone Helpline 0808 808 0000
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.