II. Indications
- Colorectal Cancer (metastatic, refractory)
III. Mechanism
- Recombinant fusion Protein that acts as a decoy for Vascular Endothelial Growth Factor (VEGF) receptors
- Competitive inhibitor of VEGF receptor binding (VEGF-A and VEGF-B)
- Blocks the VEGF Angiogenesis signaling pathway of tumor cells
- Fusion Protein has two components
- Ziv-Aflibercept also blocks placental growth factor
IV. Medications
- Ziv-Aflibercept (Zaltrap)
- Dosed IV, unlike other VEGF Inhibitors and small molecule agents
V. Dosing
- See other references for disease specific dosing protocols
VI. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters, pregnancy category X)
- Use reliable Contraception
VII. Adverse Effects
- Cardiovascular
- Severe Hypertension (including PRES)
- Arterial Thrombotic Events
- Hematologic
- Neutropenia
- Hemorrhage (esp. Gastrointestinal)
- Gastrointestinal
- Gastrointestinal fistula or perforation
- Severe Diarrhea
- Transaminase increase
- Abdominal Pain
- Decreased appetite
- Dermatologic
- Impaired Wound Healing
- Renal
- Neurologic
VIII. Resources
- Ziv-Aflibercept (DailyMed)