Classification: Anti-angiogenesis, targeted therapy
Ziv-afilbercept is a type of anti-angiogenesis agent. It works by blocking the action of a protein called vascular endothelial growth factor (VEGF), which may prevent the growth of new blood vessels that tumors need to grow. In essence, it kills tumors by cutting off their blood supply.
Ziv-afilbercept is given by intravenous (into a vein) infusion over an hour. The dose you receive is based on your body size and will be determined by your oncology team.
Ziv-afilbercept has the potential to cause several serious side effects. There are some things you can do to manage the more common side effects of Ziv-afilbercept. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you.
This medication may cause serious diarrhea and the risk of dehydration is high. If you develop diarrhea, notify your oncology team so they can help you manage it before dehydration develops. Your oncology team can recommend medications to relieve diarrhea.
Try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
For more suggestions, read the Neutropenia Tip Sheet.
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If your platelet count becomes too low, you may receive a transfusion of platelets.
Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.
Read the mouth ulcer tip sheet for more information.
Patients may experience minor bleeding, such as a nosebleed. Serious bleeding has also occurred in patients treated with this medication, including coughing up blood, bleeding into the stomach, vomiting blood, bleeding in the brain (stroke), nosebleeds and blood in the urine. People who have had serious bleeding should not take this medication. These events are uncommon, though if they occur, ziv-afilbercept should be discontinued. While a nosebleed may not seem like much of a concern, you should notify your healthcare team right away if you develop bleeding of any sort.
Patients receiving ziv-afilbercept can develop high blood pressure. Your blood pressure should be monitored at every clinic visit or every 2 weeks. If your blood pressure is elevated, you will be treated with a medication to reduce your pressure. If severe hypertension develops, ziv-afilbercept should be discontinued immediately. In both cases, your blood pressure should continue to be monitored, even if ziv-afilbercept is stopped. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.
Ziv-afilbercept can result in a serious, sometimes fatal, problem called gastrointestinal perforation, which is the development of a hole in the stomach or small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.
Ziv-afilbercept can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that ziv-afilbercept not be given for 4 weeks before or after surgery. In addition, any surgical incision should be fully healed prior to starting ziv-afilbercept. If you notice that your surgical wound has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.
Kidney damage can occur while receiving ziv-afilbercept. Your healthcare team will monitor this by periodically checking the amount of protein in your urine. If the protein levels become elevated, you may require further urine tests to evaluate your kidney function. If your kidneys become damaged, you may need to stop receiving this medication.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for a minimum of 3 months after treatment, even if your menstrual cycle stops or you believe your sperm is affected.
Stroke or heart problems, including blood clots, heart attack and chest pain can occur. If you develop any of the following, call 911 or go to the nearest emergency room: numbness or weakness on one side of the body, confusion or difficulty speaking, difficulty walking, loss of balance or coordination, sudden shortness of breath, swelling or pain in one leg, pain in the chest, left arm or jaw.
A possible, but rare, side effect is the development of a fistula, which is an abnormal passage between two body parts (for instance, a hole between the colon and vagina).
RPLS (Reversible Posterior Leukoencephalopathy Syndrome) is a syndrome that causes swelling in the brain; it can be reversed by stopping the cause - in this case, the medication.
If you develop headache, confusion, seizures or vision changes, report these to your healthcare team right away.