Nurses Compass
Drug Guide
Ziv-aflibercept
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Vascular endothelial growth factor (VEGF) inhibitor
FDA Approved Indications
- metastatic colorectal cancer, as a part of combination chemotherapy
Mechanism of Action
Ziv-aflibercept is a recombinant fusion protein that acts as a decoy receptor for VEGF-A, VEGF-B, and placental growth factor (PLGF). By binding these ligands, it prevents them from activating their natural receptors on endothelial cells, thereby inhibiting angiogenesis required for tumor growth.
Dosage and Administration
Adult: 4 mg/kg IV every 2 weeks in combination with fluorouracil, leucovorin, and oxaliplatin (FOLFOX).
Pediatric: Not approved for pediatric use.
Geriatric: No specific dose adjustment, but caution advised due to potential increased risk of adverse effects.
Renal Impairment: No specific recommendations; use with caution.
Hepatic Impairment: No specific dose adjustments; monitor closely.
Pharmacokinetics
Absorption: Administered IV; absorption phase bypassed.
Distribution: Extensive distribution, high plasma protein binding.
Metabolism: Metabolized via proteolytic degradation.
Excretion: Excreted mainly unchanged in feces and urine.
Half Life: about 6 days.
Contraindications
- Hypersensitivity to ziv-aflibercept or any component of the formulation.
Precautions
- Potential for bleeding, thromboembolic events, gastrointestinal perforation, wound healing issues, hypertension, proteinuria, adverse ocular events. Use with caution in patients with bleeding disorders or recent surgery.
Adverse Reactions - Common
- Hypertension (Reported in ≥20% of patients)
- Diarrhea (Common)
- Fatigue (Common)
Adverse Reactions - Serious
- Gastrointestinal perforation (Rare)
- Hemorrhage (Reported varies)
- Proteinuria (Reported in some cases)
- Wound healing complications (Rare)
Drug-Drug Interactions
- Potential increased bleeding with anticoagulants or antiplatelet agents.
Drug-Food Interactions
- No significant food interactions reported.
Drug-Herb Interactions
- Limited data; use caution with herbal supplements that affect bleeding or blood pressure.
Nursing Implications
Assessment: Monitor blood pressure, renal function, urinalysis for proteinuria, wound healing status, signs of bleeding, ocular health.
Diagnoses:
- Risk for bleeding, risk for hypertension, impaired skin integrity, knowledge deficit regarding therapy.
Implementation: Administer as prescribed, monitor for adverse effects, educate patient on signs to report, ensure proper infusion technique.
Evaluation: Outcome of blood pressure control, absence of bleeding complications, tumor response, patient understanding.
Patient/Family Teaching
- Report any unusual bleeding, severe chest pain, or signs of infection.
- Monitor blood pressure regularly.
- Avoid invasive procedures without healthcare provider approval.
- Attend scheduled labs and clinic visits.
Special Considerations
Black Box Warnings:
- Serious and sometimes fatal bleeding, arterial thromboembolic events, gastrointestinal perforation.
Genetic Factors: No specific genetic testing required.
Lab Test Interference: May affect coagulation parameters and urinalysis results.
Overdose Management
Signs/Symptoms: Severe bleeding, hypertension, or signs of thromboembolism.
Treatment: Supportive care, maintain blood pressure, control bleeding, no specific antidote available.
Storage and Handling
Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F), protect from light.
Stability: Stable refrigerated; vials should be used within the period specified by the manufacturer once reconstituted.