# Ramucirumab

Ramucirumab (Cyramza, Eli Lilly Nederland B.V.) has 6 EU-approved indications in 4 tumour types. 2 need a biomarker result: AFP (1) and EGFR (1).

## Approved indications

### Non-small cell lung cancer

| Biomarker requirement | Regimen | Setting | Conditions |
|---|---|---|---|
| EGFR mutation | + erlotinib | 1st line, metastatic | - |
| None | + docetaxel | 2nd line, advanced | After platinum-based chemotherapy |

### Colorectal cancer

| Biomarker requirement | Regimen | Setting | Conditions |
|---|---|---|---|
| None | + FOLFIRI (irinotecan, folinic acid, and 5-fluorouracil) | 2nd line, metastatic | After bevacizumab, oxaliplatin and a fluoropyrimidine |

### Gastric and GEJ adenocarcinoma

| Biomarker requirement | Regimen | Setting | Conditions |
|---|---|---|---|
| None | + paclitaxel | 2nd line, advanced | After platinum and fluoropyrimidine chemotherapy |
| None | Monotherapy | 2nd line, advanced | After platinum or fluoropyrimidine chemotherapy; For whom treatment in combination with paclitaxel is not appropriate |

### Hepatocellular carcinoma

| Biomarker requirement | Regimen | Setting | Conditions |
|---|---|---|---|
| Serum AFP ≥ 400 ng/ml | Monotherapy | 2nd line, advanced | After sorafenib |

## Products

### Cyramza

- Company: Eli Lilly Nederland B.V.
- Target: VEGFR2 inhibitor antibody
- Class: Other monoclonal antibodies and antibody drug conjugates
- ATC: L01FX06
- EU approval: 19 Dec 2014
- Label revised: 16 Jan 2026
- SmPC (EN): https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf
- Fachinformation (DE): https://www.ema.europa.eu/de/documents/product-information/cyramza-epar-product-information_de.pdf
- EPAR: https://www.ema.europa.eu/en/medicines/human/EPAR/cyramza

Mechanism (SmPC section 5.1): Ramucirumab binds VEGF Receptor 2 to block VEGF ligand binding and activation, inhibiting endothelial cell proliferation and migration.

## Label wording

- **Ramucirumab** (Cyramza), Gastric and GEJ adenocarcinoma, 2nd line, advanced: “Cyramza in combination with paclitaxel is indicated for the treatment of adult patients with advanced gastric cancer or gastro-oesophageal junction adenocarcinoma with disease progression after prior platinum and fluoropyrimidine chemotherapy (see section 5.1).” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)
- **Ramucirumab** (Cyramza), Gastric and GEJ adenocarcinoma, 2nd line, advanced: “Cyramza monotherapy is indicated for the treatment of adult patients with advanced gastric cancer or gastro-oesophageal junction adenocarcinoma with disease progression after prior platinum or fluoropyrimidine chemotherapy, for whom treatment in combination with paclitaxel is not appropriate (see section 5.1).” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)
- **Ramucirumab** (Cyramza), Colorectal cancer, 2nd line, metastatic: “Cyramza, in combination with FOLFIRI (irinotecan, folinic acid, and 5-fluorouracil), is indicated for the treatment of adult patients with metastatic colorectal cancer (mCRC) with disease progression on or after prior therapy with bevacizumab, oxaliplatin and a fluoropyrimidine.” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)
- **Ramucirumab** (Cyramza), Non-small cell lung cancer, 1st line, metastatic: “Cyramza in combination with erlotinib is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer with activating epidermal growth factor receptor (EGFR) mutations (see section 5.1).” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)
- **Ramucirumab** (Cyramza), Non-small cell lung cancer, 2nd line, advanced: “Cyramza in combination with docetaxel is indicated for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer with disease progression after platinum-based chemotherapy.” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)
- **Ramucirumab** (Cyramza), Hepatocellular carcinoma, 2nd line, advanced: “Cyramza monotherapy is indicated for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma who have a serum alpha fetoprotein (AFP) of ≥ 400 ng/ml and who have been previously treated with sorafenib.” [SmPC](https://www.ema.europa.eu/en/documents/product-information/cyramza-epar-product-information_en.pdf)

Source: section 4.1 of each summary of product characteristics (SmPC), EMA data as of 5 Nov 2026. AI models structured these entries and no person has checked them yet. oncolabels is a non-commercial reference for education and research and gives no medical advice; the current SmPC takes precedence.

Data under CC BY 4.0: credit oncolabels and the European Medicines Agency. Page: https://oncolabels.com/drugs/ramucirumab