Ramucirumab (trade name: Cyramza) has been approved in Germany since January 2016 for the treatment of metastatic bowel cancer. The drug is used in combination with a type of chemotherapy called FOLFIRI. FOLFIRI combines the drugs folinic acid, 5-fluorouracil and irinotecan. Ramucirumab is a treatment option for adults with metastatic colorectal bowel cancer that progresses despite treatment.

Bowel cancer almost always develops from a certain kind of bowel polyp (adenomas). These are non-cancerous (benign) growths in the mucous membrane of the bowel. Most adenomas remain small and are not dangerous. Only few of them change and become cancerous (malignant). Although the small intestine is quite a lot longer than the large intestine, bowel cancer almost always develops in the large intestine (colon) or the rectum. These types of cancer are also called colorectal carcinoma.

Bowel cancer often doesn't cause any symptoms at first, so it may remain unnoticed for a while. In advanced metastatic bowel cancer the tumor has spread to other parts of the body and complete recovery is generally no longer possible.

The drug ramucirumab is an antibody that disrupts the formation of new blood vessels. This is believed to prevent the tumor from growing any more, stopping the disease from progressing.


Ramucirumab should be used before chemotherapy. The drug is given as an infusion (IV drip).

The infusion takes about 60 minutes and is given every two weeks. The dose is determined by the patient's body weight. Treatment is stopped if the tumor continues to grow or ramucirumab is no longer tolerated.

Other treatments

Chemotherapy with FOLFIRI is usually the standard treatment option for adults with metastatic bowel cancer.


In 2016, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether people with advanced colorectal carcinoma can benefit from treatment with ramucirumab.

The manufacturer provided one study comparing the combination of ramucirumab and FOLFIRI with treatment with FOLFIRI alone. In the study, 536 men and women received ramucirumab and FOLFIRI, and another 536 people received FOLFIRI only.

The study showed different results for men and women.

Learn more

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of ramucirumab (Cyramza).