title: Incidence and management of ZIv-aflibercept related toxicities in colorectal cancer.
abstract: Ziv-afilbercept (Zaltrap, Ziv) is a humanized fusion protein constructed by joining the vascular endothelial growth factor (VEGF) binding portions of human VEGF receptors 1 and 2 to the Fc portion of human immunoglobulin IgG1. Recently, a randomized, open-label, phase III study compared 5-fluorouracil, leucovorin, irinotecan (FOLFIRI)/Ziv with FOLFIRI/placebo in patients who had been previously treated with oxaliplatin based chemotherapy for metastatic colon cancer (mCRC). Patients who had received prior bevacizumab therapy were also eligible. This study showed that the addition of Ziv improved overall survival with median survival time of 13.5 mo vs 12.06 mo in ziv vs placebo arm. Ziv also improved progression free survival from 4.67 mo to 6.9 mo with a response rate of 19.8% in the Ziv/FOLFIRI group vs 11.1% in FOLFIRI alone group. This led to the approval of Ziv in combination with FOLFIRI in metastatic colon cancer patients treated with prior oxaliplatin regimens. The most common side effects were diarrhea, stomatitis, fatigue, hypertension, weight loss, loss of appetite, abdominal pain, and headache. As the use of Ziv has become more widespread in oncology practices, familiarity with the toxicity profile of the drug and the use of practice guidelines for their treatment has become increasing important. This review will address the toxicities noted in trials using Ziv for the treatment of mCRC, and will provide recommendations for toxicity management.
authors.affiliation: Muhammad Wasif Saif, Valerie Relias, GI Oncology Exp. Therapeutic, Tufts Medical Center-Tufts Cancer Center, Boston, MA 02111, United States.
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Saif
authors.affiliation: Muhammad Wasif Saif, Valerie Relias, GI Oncology Exp. Therapeutic, Tufts Medical Center-Tufts Cancer Center, Boston, MA 02111, United States.
authors.forename: Valerie
authors.initials: V
authors.lastname: Relias
authors.affiliation: Muhammad Wasif Saif, Valerie Relias, GI Oncology Exp. Therapeutic, Tufts Medical Center-Tufts Cancer Center, Boston, MA 02111, United States.
authors.forename: Kostas
authors.initials: K
authors.lastname: Syrigos
authors.affiliation: Muhammad Wasif Saif, Valerie Relias, GI Oncology Exp. Therapeutic, Tufts Medical Center-Tufts Cancer Center, Boston, MA 02111, United States.
authors.forename: Krishna S
authors.initials: KS
authors.lastname: Gunturu
keywords: Bleeding; Colon cancer; Hypertension; Metastatic; Ziv-aflibercept