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Ziv-Aflibercept (Zaltrap®)

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OncoLink
Last Modified: September 16, 2012

Pronounced: ziv-a-FLIB-er-sept
Classification: Anti-angiogenesis, targeted therapy

About Ziv-afilbercept

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.

How to Take Ziv-afilbercept

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.

Possible Side Effects of Ziv-afilbercept

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.

Diarrhea

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.

Low White Blood Cell Count (Leukopenia or Neutropenia)

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:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bath daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your doctor or nurse before scheduling dental appointments or procedures.
• Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Platelet Count (Thrombocytopenia)

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 use a razor to shave (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).

Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
• Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.

Mouth Ulcers (Sores)

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.

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
• If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.

Read the mouth ulcer tip sheet for more information.

Hemorrhage (Bleeding)

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.

Hypertension (High Blood Pressure)

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.

Gastrointestinal Perforation

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.

Poor Wound Healing

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

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.

Reproductive Concerns

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.

Additional Rare, But Serious, Side Effects

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.