ziv-aflibercept

Contraindicated in:

OB: Pregnancy (may cause fetal harm)
Lactation: Should not be used in nursing mothers.

Use Cautiously in:

Elective surgery
Geri: ↑risk of adverse effects especially diarrhea/dehydration
Females/males with reproductive potential
Pedi: Safety and effectivenessnot established.

Adv. Reactions/Side Effects ⬆ ⬇

CNS: REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME, fatigue, headache.

EENT: dysphonia.

CV: ARTERIAL THROMBOTIC EVENTS, hypertension.

GI: GI PERFORATION, abdominal pain, anorexia, diarrhea, fistula formation, ↑liver enzymes, stomatitis.

GU: NEPHROTIC SYNDROME, ↑serum creatinine, proteinuria.

Derm: impaired wound healing, Palmar-Plantar Erythrodysesthesia Syndrome, skin hyperpigmentation.

F and E: dehydration.

Hemat: BLEEDING, NEUTROPENIA, THROMBOTIC MICROANGIOPATHY, leukopenia, thrombocytopenia.

Metab: weight loss.

Interactions ⬆ ⬇

Drug-Drug:

↑risk of bone marrow depression with other antineoplastics or radiation therapy.

Availability ⬆ ⬇

Solution for intravenous administration (requires dilution): 25 mg/mL;

Route/Dosage ⬆ ⬇

IV (Adults): 4 mg/kg every 2 wk continued until disease progression or unacceptable toxicity.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to human Vascular Endothelial Growth Factor (VEGF-A), resulting in decreased neovascularization and decreased vascular permeability. Also inhibits proliferation of endothelial cells, decreasing growth of new blood vessels.

Therapeutic Effects:

Decreased spread of mCRC.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: fusion proteins

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: 6 days (range 4–7 days).

Time/Action Profile ⬆ ⬇

(improved survival)

ROUTE	ONSET	PEAK	DURATION
IV	4–6	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose of therapy and potential adverse effects to patient.
Advise patient to notify health care professional immediately if signs of bleeding (lightheadedness), hypertension (severe headache, lightheadedness, neurologic symptoms), severe diarrhea, vomiting, severe abdominal pain, fever or other signs of infection, or symptoms of arterial thromboembolic events occur.
Advise patient to maintain adequate hydration to minimize risk and to notify health care professional promptly if signs and symptoms of reversible posterior leukoencephalopathy syndrome (RPLS) (headache, seizures, weakness, confusion, high BP, blindness or change in vision, problems thinking) occur. Symptoms usually resolve within days.
Advise patient to notify health care provider of therapy prior to surgery or if had recent surgery. Ziv-aflibercept should be suspended for at least 4 wk prior to major surgery and until surgical wounds fully healed. For minor surgery, such as central venous access port placement, biopsy, and tooth extraction ziv-aflibercept may be initiated/resumed once wound is fully healed. Discontinuation is needed in patients with compromised wound healing.
Inform female patient that ziv-aflibercept can cause fetal harm. Advise women with reproductive potential and men of the need for effective contraception during and for at least 3 mo after completion of therapy. Notify health care provider immediately if pregnancy is planned or suspected or if breast feeding.
Emphasize importance of monitoring lab values to monitor for adverse reactions.

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Indications ⬇

Contraind./Precautions ⬆ ⬇