Ziv-aflibercept Disease Interactions

Gastrointestinal (GI) perforation including fatal GI perforation can occur in patients receiving ziv-aflibercept. Care should be exercised when using this agent in patients at risk of GI perforation. It is recommended to monitor patients for signs and symptoms of GI perforation and discontinue therapy in patients who experience GI perforation.

Ziv-aflibercept can impair wound healing, cause gastrointestinal (GI) perforation, and cause severe and sometimes fatal hemorrhages including GI hemorrhage. It is recommended to suspend the use of ziv-aflibercept for at least 4 weeks prior to elective surgery and do not resume treatment for at least 4 weeks following major surgery and until the surgical wound is fully healed. It is recommended to discontinue the use of this agent in patients with compromised wound healing.

No dosage modification is recommended for patients with mild and moderate hepatic impairment. Monitor closely when administering ziv-aflibercept to patients with severe hepatic impairment as this agent has not been studied in these patients.

The use of ziv-aflibercept increases the risk of Grade 3-4 hypertension. It is recommended to monitor blood pressure every two weeks or more frequently as clinically indicated during treatment. Patients should be treated with appropriate antihypertensive therapy and continue monitoring blood pressure regularly. Care should be exercised when treating patients with preexisting hypertension. Temporarily suspend treatment in patients with uncontrolled hypertension until controlled and permanently reduce the dose to 2 mg per kg for subsequent cycles. Discontinue therapy with ziv-aflibercept in patients with hypertensive crisis or hypertensive encephalopathy.

The use of ziv-aflibercept may increase the incidence of neutropenic complications (febrile neutropenia and neutropenic infection). It is recommended to monitor CBC with differential count at baseline and prior to initiation of each cycle of therapy. Exercise care when using this agent in patient with neutropenic complications. Delay the use of ziv-aflibercept until neutrophil count is at or above 1.5 × 109/L.

Severe proteinuria, nephrotic syndrome, and thrombotic microangiopathy (TMA) occurred more frequently in patients treated with ziv-aflibercept. It is recommended to monitor proteinuria by urine dipstick analysis and/or urinary protein creatinine ratio for the development or worsening of proteinuria during therapy. Suspend or discontinue treatment in patients who develop nephrotic syndrome or TMA as appropriate.