ziv-aflibercept

High Alert

Used in combination with 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) for metastatic colorectal cancer that is resistant to/progressed after an oxaliplatin-containing regimen.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Elective surgery;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of adverse effects in older adults, especially diarrhea/dehydration.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARTERIAL THROMBOTIC EVENTS, hypertension

Derm: impaired wound healing, palmar-plantar erythrodysesthesia syndrome, skin hyperpigmentation

EENT: dysphonia

F and E: dehydration

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

GU: ↑serum creatinine, ↓fertility, NEPHROTIC SYNDROME, proteinuria

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

Metab: weight loss

Neuro: fatigue, headache, REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME (RPLS)

Interactions ⬆ ⬇

Drug-drug:

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

Availability ⬆ ⬇

Solution for injection: 25 mg/mL

Route/Dosage ⬆ ⬇

IV (Adults ): 4 mg/kg every 2 wk 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 colorectal cancer.

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 ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	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 (light-headedness), hypertension (severe headache, light-headedness, 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 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.
Rep: May cause fetal harm. Advise women of reproductive potential of the need for effective contraception during and for at least 3 mo after completion of therapy. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding.
Emphasize importance of monitoring lab values to monitor for adverse reactions.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

0024- sanofi-aventis U.S. LLC
- 0024-5840- ZALTRAP
  - 0024-5840-01- 1 VIAL in 1 CARTON (0024-5840-01) / 4 mL in 1 VIAL

0024- sanofi-aventis U.S. LLC
- 0024-5841- ZALTRAP
  - 0024-5841-01- 1 VIAL in 1 CARTON (0024-5841-01) / 8 mL in 1 VIAL

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Indications ⬇