Ramucirumab with Abraxane

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scohn
Ramucirumab with Abraxane

Well, here we are again, asking more questions....

So, as you might have inferred from a previous post, our oncologist is confering with his tumor board today on recommendations for my wife's next treatments, and we should hear back tomorrow.

My question relates to one of the options, continuing with abraxane but adding ramucirumab.  I have tried to look it up, but I am not clear on the real side-effect profile that increases with ramucirumab.  I see that there are vascular risks (e.g. arterial perforation), bleeding (e.g. nose), as well as nausea, low white cells, and rash.  But since many of these studies are from ramucirumab cases with different combinations of other drugs, it is hard to tease apart what the increased frequency of side-effects is with abraxane.  For example, the side effects with old style paclitaxel alone are much greater than with abraxane alone, yet many of the studies seem to have been done with paclitaxel and ramucirumab.

I guess my question is whether there is a clinical sense (or anecdotal sense for anyone out there reading this) of what the intensity and frequency of increased side effects are for the ramucirumab when given with abraxane.  We may not even be going this route, but if we do we want to know what side effects to prepare for.

Thanks, scohn

JanineT Forum M...
Hi Scohn, I'll get Dr. West's

Hi Scohn,

 

I'll get Dr. West's input.  My guess is that the side effects would be similar to those of taxol combined with ramucirumab minus the side effects you get from the solvent in taxol.  But assuming especially in cancer treatment can easily make you wrong.  Surely, the side effects of pac and ram are less that taxol and ram.  

 

Janine

Dr West
Little data on paclitaxel/ramucirumab combo in NSCLC

I'm not aware of much data on this combination with either taxol (paclitaxel) or Abraxane (nab-paclitaxel), but in general, ramucirumab (Cyramza) doesn't add many side effects. There's a risk of some bleeding, but it's usually quite minor, and the biggest risk is developing protein in the urine, which has increasing risk with ongoing treatment.  There's a mildly increased risk of worse bone marrow suppression, but not a big change. 

Overall, in the world of lung cancer, there's far more evidence on the combination of ramucirumab with Taxotere (docetaxel), but I think most people would say that there's unlikely to be any marked differences with a different taxane.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

scohn
New treatment line...

Thanks everyone.  I really appreciate it.

We talked to the oncologist today, and based on recommendations from the clincial trial doctor, the oncologist suggested (and we agreed) the next line will be T-DM1 (Kadcyla).  It had already been on my radar due to its good effect in the European study looking at various HER2 treatments, and I was actually going to ask about with the oncologist today, but he brought it up first!

The Abraxane with ramucirumab is still a possibility down the road, but given the increased risk of bleeding and little liklihood of it doing much more than the abraxane alone (and the increased adema and neuropathy from the ongoing abraxane) he said the Kadcyla looked like a better option.  The only drawback is that Kadcyla is approved for Breast Cancer (and not NSCLC) in the US, so we have to go through a 2 week period of asking the insurance company for approval, and getting rejected, so that they can get the drug directly from the company.

The oncologist said that this will be the first case in which he is using the drug for lung cancer (We're number 1! We're number 1!)

So, in 2 weeks my wife is on to Kadycla!  It looks hopeful, as the Phase 2 trial that was reported last year showed about an 80% partial response/stable rate.

Onward!

Wife, non-smoker, dx 4/24/15 adeno NSCLC stage IV. HER2 Exon 20. 6x Carbo/Alimta; effect. 9/15 Alimta maint; ineffect. 11/15 - Opdivo; ineffect. 4/16 - ptK7 trial; effective 1.5 yr. 9/17 Gemzar; effective 16 mo. 8/18 -TAK788 Trial. 10/18 start Abraxane. 7/19 start Kadcyla.

Jim C Forum Mod...
Jim C Forum Moderator's picture
New treatment line...

Hi scohn,

 

That sounds like a good option, especially since Abraxane with ramucirumab will still be a possibility, not to mention anything else that may be available if and when necessary. I hope the side effects of Kadycla are minimal, and that your wife has a good response to it.

 

Thanks for keeping us updated.

 

Jim C

Forum moderator

 

JanineT Forum M...
Kadcyla for her cancer too.

Or Kadcyla for her HER2 cancer too. I had to look that one up and it looks really promising.  Especially since she's a good responder.  I'm glad she's getting a break from the taxane I know the side effects must be picking up speed.  Her body will have a chance to recover before the next go round of it.  I hope your wife does very well for a long time and the side effects are minimal to none.   Here's to being #1

 

All best,

Janine

scohn
Thanks

Thanks Jim and Janine.  As always I am so grateful for the support!  So, my wife will have had a break of about 4 weeks before the Kadcyla treatment starts, but the attached poison on the ADC is another micrtubule poison, so it is not clear how much of a break from the neuropathy she will get.

Wife, non-smoker, dx 4/24/15 adeno NSCLC stage IV. HER2 Exon 20. 6x Carbo/Alimta; effect. 9/15 Alimta maint; ineffect. 11/15 - Opdivo; ineffect. 4/16 - ptK7 trial; effective 1.5 yr. 9/17 Gemzar; effective 16 mo. 8/18 -TAK788 Trial. 10/18 start Abraxane. 7/19 start Kadcyla.