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Active Substance: aflibercept
Common Name: aflibercept
ATC Code: L01XX44
Marketing Authorisation Holder: Sanofi-Aventis Groupe
Active Substance: aflibercept
Status: Authorised
Authorisation Date: 2013-02-01
Therapeutic Area: Colorectal Neoplasms
Pharmacotherapeutic Group: Antineoplastic agents

Therapeutic Indication

Treatment of metastatic colorectal cancer (MCRC).

What is Zaltrap?

Zaltrap is a medicine that contains the active substance aflibercept. It is available as a concentrate to be made into a solution for infusion (drip) into a vein.

What is Zaltrap used for?

Zaltrap is used to treat adults with metastatic colorectal cancer (cancer of the large bowel that has spread to other parts of the body) for whom treatment based on another medicine, oxaliplatin, has not worked or the cancer got worse. Zaltrap is used with FOLFIRI, which is a treatment combining the medicines irinotecan, 5-fluorouracil, and folinic acid.

The medicine can only be obtained with a prescription.

How is Zaltrap used?

Treatment with Zaltrap should be supervised by a doctor who is experienced in using anticancer medicines.

Zaltrap is given as an infusion into the vein over one hour, at a dose of 4 mg per kilogram body weight. This is then followed by the FOLFIRI treatment. This cycle of treatment is repeated every two weeks, until the disease gets worse or the patient cannot tolerate the treatment. Treatment should be discontinued, delayed, or the dose may have to be adjusted, in patients who develop certain side effects.

How does Zaltrap work?

The active substance in Zaltrap, aflibercept, is a protein that binds to vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF), substances that circulate in the blood and makes blood vessels grow. By binding to VEGF and PlGF, aflibercept stops them having an effect. As a result, the cancer cells cannot develop their own blood supply and are starved of oxygen and nutrients, helping to slow down the growth of tumours.

How has Zaltrap been studied?

The effects of Zaltrap were first tested in experimental models before being studied in humans.

Zaltrap was investigated in one main study involving 1,226 adults with metastatic colorectal cancer that had not responded to oxaliplatin-based treatment. Zaltrap was compared with placebo (a dummy treatment) when added to FOLFIRI. The main measure of effectiveness was the average length of time that patients survived after treatment.

What benefit has Zaltrap shown during the studies?

Zaltrap was more effective than placebo at increasing survival of patients: patients treated with Zaltrap plus FOLFIRI lived an average of 13.5 months, whereas patients treated with placebo and FOLFIRI lived an average of 12.1 months.

What is the risk associated with Zaltrap?

The most common side effects with Zaltrap (seen in more than 20 patients in 100) are leucopenia and neutropenia (low levels of white cells in the blood, including the type that fight infections), diarrhoea, proteinuria (protein in the urine), increased blood levels of liver enzymes (aspartate and alanine transaminases), stomatitis (inflammation of the mouth), fatigue, thrombocytopenia (low blood platelet counts), hypertension (high blood pressure), weight loss, decreased appetite, epistaxis (nose bleeds), abdominal pain, dysphonia (speech disturbance), increases in creatinine in the blood (a marker of kidney problems), and headache. The most common effects that led to treatment being permanently stopped were problems with the circulation including hypertension, infections, fatigue, diarrhoea, dehydration, stomatitis, neutropenia, proteinuria, and pulmonary embolism (a clot in a blood vessel supplying the lungs).

For the full list of all side effects reported with Zaltrap, see the package leaflet.

Zaltrap must not be used in people who are hypersensitive (allergic) to aflibercept or any of the other ingredients. Although medicines containing the same active substance are available for injection into the eye, Zaltrap must not be injected into the eye as it was not developed for such use and may cause local damage.

Why has Zaltrap been approved?

Although Zaltrap is associated with significant side effects, which can be severe enough to force treatment to be stopped, the results of the large main study show that there is a small but clinically significant benefit in prolonging the life of treated patients in whom previous treatment failed. Overall, the CHMP decided that Zaltrap’s benefits are greater than its risks and recommended that it be given marketing authorisation.

What information is still awaited for Zaltrap?

The company that makes Zaltrap will analyse the blood and tissue of patients involved in the clinical-trial programmes. This is to try to identify those patients who are more likely to respond to treatment.

Other information about Zaltrap

The European Commission granted a marketing authorisation valid throughout the European Union for Zaltrap on 1 February 2013.

For more information about treatment with Zaltrap, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.