by Dr. C.H. Weaver M.D. 5/2019
Cyramza™ (ramucirumab) when combined with Taxotere® (docetaxel) extends overall survival in patients with non-small cell lung cancer (NSCLC) compared to standard second-line therapy with Taxotere alone. When combined with Tarceva in EGFR positive NSCLC patients, Cyramza also delays cancer progression compared to Tarceva alone.(1-5)
Cyramza (ramucirumab) is a recombinant human IgG1 monoclonal antibody that targets vascular endothelial growth factor receptor 2 (VEGF-R2) which inhibits the growth of new blood vessels in tumors and, therefore, slows tumor growth.
Cyramza is approved by the US Food and Drug Administration in combination with Taxotere chemotherapy, to treat metastatic NSCLC that has progressed following platinum-based therapy. (3,4)
The RELAY Clinical Trial
In June 2019 it was also announced that the phase 3 RELAY study of Cyramza met its primary endpoint of improving progression-free survival (PFS). Cyramza when used in combination with Tarceva (erlotinib) when compared to Tarceva alone as a first-line treatment in patients with metastatic NSCLC whose tumors have activating EGFR mutations significantly delayed the time to cancer recurrence.(2,5)
Follow up publication in Lancet was reported in Sept 2019; EGFR mutated NSCLC patients treated with Cyramza plus Tarceva experienced a clinically meaningful improvement in median PFS by seven months compared to placebo plus Tarceva alone. Improvements were also consistently seen across all specified subgroups, including patients with tumors that had exon 19 and 21 mutations. Overall survival data is still and will be published in the future however the average survival duration with Cyramza plus Tarceva was 19 months compared to only 7 months for Tarceva alone. (5)
REVEL Clinical Trial
As part of the REVEL trial, Dr. Maurice Perol et al tested the combination therapy against the standard Taxotere therapy in 1253 stage IV NSCLC patients who had progressed either during or after previous treatment.(1)
Overall survival for the combination therapy was 10.5 months, while that of the Taxotere arm was 9.1 months. Progression-free survival was 4.5 months versus 3 months. The combination therapy showed an objective response rate of 23%response compared to 14% for Taxotere.
There were a number of grade 3 adverse events associated with the Cyramza treatment, including neutropenia, febrile neutropenia, fatigue, leukopenia, hypertension, and pneumonia. The number of treatment-related adverse events that led to death was comparable.
- Perol M, et al. REVEL: A randomized, double-blind, phase III study of docetaxel and ramucirumab versus docetaxel and placebo in the second-line treatment of stage IV non-small cell lung cancer following disease progression after one prior platinum-based therapy. ASCO 2014; Abstract LBA8006.
- Larkins E, Scepura B, Blumenthal GM, et al. U.S. Food and Drug Administration approval summary: ramucirumab for the treatment of metastatic non-small cell lung cancer following disease progression on or after platinum-based chemotherapy. Oncologist. 2015;20:1320-1325.
- CYRAMZA Prescribing Information. Eli Lilly and Company. Indianapolis, IN.