ramucirumab + cyclophosphamide + vinorelbine

A combination regimen consisting of **ramucirumab**, a fully human monoclonal antibody targeting the vascular endothelial growth factor receptor 2 (VEGFR-2); **cyclophosphamide**, a cytotoxic alkylating agent; and **vinorelbine**, a vinca alkaloid that inhibits microtubule assembly. This combination is investigated as an antineoplastic strategy for pediatric and young adult patients with relapsed, recurrent, or refractory desmoplastic small round cell tumor (DSRCT), aiming to enhance therapeutic efficacy through both targeted anti-angiogenic and cytotoxic mechanisms. Ramucirumab blocks angiogenesis by specifically inhibiting VEGFR-2-mediated signaling, cyclophosphamide induces DNA crosslinking and cell death in dividing cells, and vinorelbine disrupts mitosis by interfering with microtubule polymerization[1][2][3][4][7].