In 2019, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether ramucirumab has any advantages or disadvantages in the treatment of advanced liver cancer compared to cabozantinib or BSC.
The manufacturer provided two studies for the purpose of this comparison. In the studies, 316 patients received treatment with ramucirumab and 226 were given a placebo. Both groups also had BSC. The studies only included people who could no longer have surgery to cure the cancer (e.g. to remove the tumor) and whose liver function had only slightly worsened. Despite the advanced stage of the disease, the patients were otherwise in good general health at the beginning of the study. The study found the following for this group of patients:
What are the advantages of ramucirumab?
Life expectancy: The studies show that ramucirumab has an advantage here: In these groups, participants passed away within an average of about 8 months (median value), compared to 5 months in the placebo group.
Severe gastrointestinal problems: The studies suggest that ramucirumab has an advantage in terms of these severe side effects. About 9 out of 100 people who received ramucirumab had these side effects, compared to only 15 out of 100 people who received a placebo.
Hyperbilirubinemia (increased concentration of bilirubin in the blood): Bilirubin is formed by the breakdown of hemoglobin, the pigment that gives red blood cells their red color. The studies also suggest that ramucirumab has an advantage over the placebo in terms of this severe side effect.
What are the disadvantages of ramucirumab?
Severe high blood pressure: The studies suggest that ramucirumab has a disadvantage here: 11 out of 100 people who received ramucirumab had very high blood pressure as a side effect, compared to only 3 out of 100 people who received the placebo.
Headache: Here too, the studies suggest that it has a disadvantage: 18 out of 100 people who received ramucirumab had headaches, compared to only 6 out of 100 people who received the placebo.
The studies suggest that ramucirumab also has a disadvantage in terms of edemasin the lower legs or feet and diseases affecting the genitals and mammary glands.
Severe side effects: Although ramucirumab had some advantages and disadvantages in terms of certain severe side effects, this was not so for the severe side effects as a whole: About half of the people in each group had severe side effects. So there was no difference between ramucirumab and the placebo.
Treatment stopped due to side effects: There was no difference between the treatment groups here either.
What remains unanswered?
Symptoms of the disease, overall health and health-related quality of life: The manufacturer didn’t provide any suitable data on these aspects.