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VEGF Trap
ZIV-AFLIBERCEPT (ZALTRAP®)
What malignancy is ziv-aflibercept approved for?
• Metastatic colorectal cancer
How does ziv-aflibercept work?
• Ziv-aflibercept works by inhibiting angiogenesis, essential for tumor growth
• Ziv-aflibercept is a recombinant fusion protein consisting of portions of the binding domains for vascular endothelial growth factor receptor-1 and -2 (VEGFR1-2), attached to the Fc portion of human immunoglobulin G1 (IgG1), creating a “VEGF Trap” protein
• This fusion protein acts as a decoy receptor for VEGF-A, VEGF-B, and placental growth factor (PIGF), thus preventing VEGFR binding and activation of angiogenesis
What is the usual dose of ziv-aflibercept?
• 4 mg/kg intravenously (IV) over 1 hour every 2 weeks
Is ziv-aflibercept metabolized/eliminated renally or hepatically?
• Ziv-aflibercept is neither metabolized hepatically nor eliminated renally
Are there drug interactions with ziv-aflibercept?
• No clinically important drug-drug interactions have been reported for ziv-aflibercept
What are the most common adverse effects of ziv-aflibercept?
• Headache, fatigue
• Hypertension
• Bleeding
• Gastrointestinal (GI) perforation, fistula formation, and delayed wound healing (all rare but possible)
– It is recommended to suspend ziv-aflibercept at least 4 weeks prior to surgery and to wait at least 4 weeks after surgery (and after wound has fully healed) to resume therapy
• Proteinuria
• Venous thromboembolism (VTE) and arterial thromboembolic events (transient ischemic attacks [TIAs], cerebrovascular accidents [CVAs], angina, etc.)
• Dysphonia
• Increased liver function tests (LFTs)
• Diarrhea, mucositis
• Hand-foot syndrome, skin hyperpigmentation
• Neutropenia and thrombocytopenia
• Infections
What is the emetogenicity level of ziv-aflibercept?
• Ziv-aflibercept is categorized as low emetic risk (10%–30%)
Is ziv-aflibercept a vesicant or irritant?
• Ziv-aflibercept is neither a vesicant nor an irritant