Ziv-Aflibercept (Intravenous)

The Ziv-Aflibercept injection is used for the treatment of advance cancer of the rectum or colon in patients who have not seen the desired effect from other cancer treatments.


The Ziv-Aflibercept injection is a form of chemotherapy that is used in patients who have seen poor results from the use of other cancer treatments. It is used to combat advanced cancer of the colon or rectum and is usually given in conjunction with other medicines.

Ziv-Aflibercept changes the amount of blood that is able to reach a tumor and reduces its ability to grow.

Ziv-Aflibercept works by interfering with the process of angiogenesis, which triggers new blood vessel formation. By limiting the number of new blood vessels the tumor is receiving, regression can be achieved. As healthy tissue also uses angiogenesis to reproduce, there will be unwanted side effects to this interference.

This medicine is to be administered by, or under the direct supervision of, a doctor only.

Treatment is given as a solution through IV over the period of one hour. If further treatments of chemotherapy are to be given on the same day, Ziv-Aflibercept should be given to the patient first.

Among other side effects, this treatment will lower the immune system of the patient and hinder their ability to fight infection. Patients should avoid people with infections and take precautions to avoid cuts and bruises at all times.

Condition treated

  • Advanced colon or rectum cancer

Type of medicine

  • Chemotherapy

Side effects

As a form of chemotherapy, Ziv-Aflibercept works by attacking cells. The treatment cannot distinguish between healthy and cancerous cells, so the medication will also attack healthy parts of the body and lead to unwanted side effects. Many of these will reverse immediately once treatment is stopped, but others can be ongoing. Not all side effects listed here will be experienced and many can be managed with the assistance of a healthcare provider.

The following side effects are considered common and will occur in nearly one-third of patients:

  • Decrease in white and red blood cells. This can increase the risk of infection, anemia and bleeding.
  • Diarrhea
  • Increase in blood liver enzymes
  • Protienuria or the increased presence of protein in the urine.
  • Mouth sores
  • Tiredness
  • Infection
  • Hypertension
  • Bleeding
  • Decreased appetite or loss of appetite
  • Weight loss

The following list of side effects are uncommon and occur in less than one-third of patients:

  • Difficulty speaking
  • Headaches
  • Increased creatinine
  • Abdominal pain
  • Shortness of breath
  • Swelling, redness and/or pain in the hands and feet
  • Peeling of the skin on palms of hands and/or the soles of the feet
  • Sore or red eyes

In rare cases, these serious complications from the use of Ziv-Aflibercept can occur:

  • Perforation of the gastrointestinal tract
  • Blood clots
  • Impaired healing of wounds
  • Uncontrolled bleeding

Some side effects can be very serious and it is important that you contact your doctor right away if you experience them.

Seek medical advice immediately whether night or day if you experience any of the following side effects to the treatment:

  • Chest pain
  • Shortness of breath
  • Unusual bleeding
  • Severe headache
  • Lightheadedness, numbness, tingling, difficulty speaking and change in thought process
  • Fever of 100.5ºF or higher
  • Chills

If you experience any of the following symptoms you should seek medical attention but do not need to attend the emergency room. Contact your doctor within 24 hours of the occurrence of the following side effects:

  • Nausea that is not relieved by prescribed medication
  • Excessive vomiting (more than four to five times in 24 hours)
  • Severe diarrhea (more than four to six times in 24 hours)
  • Black stools
  • Bloody stools
  • Blood in urine
  • Yellowing of skin or eyes
  • Urination pain or burning
  • Extreme fatigue
  • Mouth sores

Other side effects may occur that are not listed here. In this case, you should inform your healthcare professional. If any side effects become bothersome or are ongoing, inform your healthcare professional and they may be able to help to relieve the effects.


You will need to be regularly checked by your doctor while undergoing this treatment. Your doctor will monitor side effects and check your response to therapy. Blood samples will be taken to monitor your blood count and the function of the kidney and liver.

The solution should be clear, colorless to pale yellow. Do not use if the solution appears discolored or cloudy.

Dilute correct dose in 0.9% NaCl or D5W to concentration of 0.6-8mg/mL.

Use PVC infusion bags containing DEHP or polyolefin infusion bags only.

The dose of this medication that you receive will depend on your body weight, on other medications you are receiving and other health conditions that you might have. The following is an indication only; your doctor will determine the correct dose for you.

The recommended Ziv-Aflibercept dose is 4 mg/kg. This is to be administered as an IV infusion over a 60 minute period. Doses should be administered every two weeks in combination with other medication regimens.


In deciding to use this medicine, it is important that you share all relevant information with your doctor. This includes all medicines that you are taking, all allergies that you have and all other medical conditions that you have, or have had, in the past.

Existing medical problems can be worsened by use of this medication. It is especially important that you tell your doctor if you have suffered from, or do suffer from, any of the following conditions:

  • Angina
  • Bleeding problems
  • Heart problems
  • Hypertension
  • Kidney disease
  • Proteinuria
  • Neutropenia
  • Stomach problems
  • Intestinal problems
  • Transient Ischemic Attacks or small strokes
  • Wound healing problems.


Tell your doctor about all other medications that you are taking, including over the counter medicines, herbal remedies and vitamins.

Do not receive any kind of immunization or vaccination. Ziv-Aflibercept will lower your immune system and immunizations and vaccines can lead to you becoming infected with the condition that you were trying to protect yourself against. Discuss any injections with your doctor before proceeding.

Do not undergo procedures, surgery or dental work without discussing this with your doctor first. This treatment can lead to excessive bleeding, so treatment can be hampered and dangerous. There will also be an increased risk of infection afterwards.

Do not take this medication if you are pregnant. Treatment has been shown to be harmful to the fetus.

Do not breastfeed while taking Ziv-Aflibercept. Traces have been shown to pass through in the milk.

Women should avoid becoming pregnant while taking this medication. Use effective contraceptive and discuss this with your doctor. You should avoid pregnancy for at least three months following cessation of the treatment.

This treatment will increase your risk of infection. Wherever it is possible to do so, avoid people with infections. If you think you may have an infection, check with your doctor immediately.

Tell your doctor immediately if you cough up blood or notice any unusual bleeding.

Be careful when cleaning your teeth, flossing or using a toothpick. Your dentist or doctor will be able to recommend other ways in which you can practice oral hygiene.

Only touch your eyes or the inside of your nose if you have washed your hands immediately before.

Be careful when using sharp objects.

Avoid all situations in which bruising could occur, including all contact sports.

There is an increased risk of hemorrhage when taking this medication. In some cases, severe or even fatal hemorrhaging can occur. Patients must be monitored for signs of bleeding and the treatment should never be administered in cases of severe hemorrhage.

There is an increased risk of gastrointestinal perforation when using this medicine. Discontinue use if this occurs.

Wound healing will be impaired while taking this medication. If elective or major surgery needs to be carried out then the therapy should be suspended for no less than four weeks prior to surgery. It can be resumed no less than four weeks after surgery. Only resume treatment once wounds have healed completely. If wound healing appears compromised, do not restart treatment.

Increased risk of RPLS or posterior reversible leukoencephalopathy syndrome. MRI will be required to confirm presence. Treatment should be discontinued if present. Most cases of RPLS will recover in a matter of days after discontinuation, but in some cases, there can be ongoing problems or even complications leading to death.


Store unopened vials in a refrigerator at 2-8 °C and protect from exposure to the light.

Dispose of any opened vials in the proper manner.

Store diluted bags in a refrigerator at 2-8 °C for up to four hours. After this time, dispose of the solution.

Discard any unused portions of the solution in the proper manner.


The use of Ziv-Aflibercept is often concurrent with other treatments and is used in cases where patients have not responded satisfactorily to other medications. It is used for the treatment of colon or rectum cancers.

Ziv-Aflibercept is a form of chemotherapy that attacks the process of angiogenesis, which triggers new blood vessel formation. The desired impact is the limiting of blood that reaches the colon or rectal cancer and can trigger remission in the cancer.

As the treatment cannot distinguish between healthy cell reproduction and cancerous cells, there will be unwanted side effects that occur from the use of this drug. Most are manageable medical conditions, but others are very serious and will require immediate medical attention.

Your doctor will need to monitor you regularly when you are taking this medication so that they can check your progress and look for any signs of serious complications from the drug.

Your risk of infection will increase when using this treatment, so you should avoid people with infections wherever this is possible. You will also have less ability for wounds to heal, so you will need to be more cautious and avoid cuts and bruises at all times.

Ziv-Aflibercept is diluted and administered over a period of one hour through IV and should be taken before any other chemotherapy treatments that you are receiving at the same time.

This treatment should not be used if the patient is pregnant and the patient should not breastfeed when undergoing treatment. Both male and female patients should also avoid impregnation when taking this medication and for a further three months after treatment is complete.

Last Reviewed:
December 22, 2017
Last Updated:
April 05, 2018
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