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Zirabev: What Is It and How Does It Work?

Zirabev patient

Zirabev is an anticancer drug with an active component, “bevacizumab-bvzr.” It is used to treat several types of cancer and belongs to the class of vascular endothelial growth factor (VEGF) inhibitors that targets VEGF proteins and blocks their activity. In cancer patients, the VEGF proteins overexpress and are typically involved in forming new blood vessels within the cancer cells to provide cells with oxygen and other nutrients needed for their growth and uncontrolled division. 

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In 2019, the FDA approved Zirabev as a biosimilar version of Avastin (an already FDA-authorized biological drug) as it has the active substance, “bevacizumab.” Compared to Avastin, it offers the same effectiveness, works the same way, and shows the same side effects. 

What Is Zirabev Used To Treat?

Zirabev is used to treat six types of advanced forms of cancer with the following characteristics:

  • Cancer that has spread to other areas or has not responded or been treated well previously
  • Cancer that recurs (comes back) or becomes worse after previous treatment
  • Cancer that cannot be removed with surgery
  • Cancer that is resistant to platinum-based chemotherapy

Depending on the cancer stage and previous treatment’s failure, Zirabev can be either used as single-agent therapy or, in some cases, combined with chemotherapy agents. 

Metastatic Colorectal Cancer (mCRC)

Metastatic colorectal cancer is an advanced form of cancer that initially began in the colon or rectum but has spread to other body areas. If a patient has not previously been treated, Zirabev is used as a first-line treatment in combination with fluorouracil-based chemotherapy. 

In other cases, if the patient has been treated previously with bevacizumab (Zirabev, Avastin, or Mvasi), and their cancer did not respond well, Zirabev is then used as second-line treatment in combination with chemotherapy. 

Metastatic Renal Cell Carcinoma (mRCC)

Zirabev is used in combination with interferon-alpha to treat patients who have metastatic renal cancer (kidney cancer that has spread to other areas). 

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Ovarian cancer represents a group of cancer that begins in the women’s ovaries and spreads to other areas, such as the fallopian tube and the peritoneum. 

Patients with this cancer are typically treated with Zirabev in combination with chemotherapy drugs (paclitaxel and carboplatin), followed by Zirabev alone. 

If a patient’s cancer is sensitive to platinum-based chemotherapy or comes back after six months, Zirabev is first used in combination with chemotherapy agents (paraplatin and either paclitaxel or gemcitabine), followed by Zirabev as a single-agent therapy. 

Metastatic Cervical Cancer

In this cancer, Zirabev is used in combination with chemotherapy agents (topotecan and paclitaxel or cisplatin and paclitaxel). 

Non-squamous, Non-small Cell Lung Cancer

Zirabev is used as a first-line treatment combined with chemotherapy agents (paclitaxel and carboplatin) in patients whose tumor is metastatic, persistent, and unresectable (the cancer cannot be removed via surgery). 

Recurrent Glioblastoma

Zirabev is used as a single agent to treat glioblastoma, an aggressive form of brain and spinal cord cancer. 

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How Does Zirabev Work?

Zirabev works to slow down the growth of cancers. It contains an active component, “bevacizumab-bvzr,” which is a recombinant monoclonal (IgG1) antibody designed to recognize and bind to VEGF proteins (that typically encourages the blood vessel’s formation to provide cancer with essential nutrients to grow and divide).

Upon binding to VEGF protein, it inhibits VEGF activity. As a result, the blood vessels do not grow within the cancer cells. Due to a lack of nutrients and oxygen supply, cancer cells starve and do not progress further.

Dạng bào chế và nồng độ

Zirabev is available in a single-dose vial that is administered intravenously. The single-dose vial is available in:

  • 100 mg/4 ml strength (contains 25 mg bevacizumab-bvzr/ml) 
  • 400 mg/16 ml strength (contains 25 mg bevacizumab-bvzr/ml)

Zirabev Dosing Information

The doses are set according to the type of cancer being treated and the current body weight. The following are the recommended doses  according to the FDA:

For Metastatic Colorectal Cancer (mCRC)

Patients suffering from mCRC should take the following Zirabev doses in combination with intravenous fluorouracil-based chemotherapy:

  • 5 mg/kg every two weeks in combination with bolus-IFL
  • 10 mg/kg every two weeks in combination with FOLFOX4
  • For a patient who showed progress with a bevacizumab product-containing regimen, 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks in combination with chemotherapy based on fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin. 

For Metastatic Renal Cancer

The recommended dose of Zirabev in combination with interferon-alpha is 10 mg/kg intravenously every 2 weeks. Zirabev can also be used as monotherapy at a dose of 10 mg/kg every 2 weeks. 

For Metastatic Cervical Cancer

The recommended dose is 15 mg/kg intravenously every three weeks in combination with topotecan and paclitaxel or with cisplatin and paclitaxel. 

For Ovarian Cancer

The recommended dose for ovarian cancer patients is adjusted according to their stage, treatment sensitivity, and resistance. 

  • For advanced stage III/IV cancer followed by initial surgery, the dose of Zirabev in combination with paclitaxel and carboplatin is 15 mg/kg every 3 weeks for up to 6 cycles, followed by a single (Zirabev alone) dose of 15 mg/kg every 3 weeks for a total of up to 22 cycles.
  • For platinum-resistant chemotherapy, the Zirabev dose in combination with topotecan, pegylated liposomal doxorubicin, or paclitaxel is 10 mg/kg every 2 weeks. In combination with just topotecan, the dose is 15 mg/kg every 3 weeks. 
  • For platinum-sensitive chemotherapy, the recommended dose of Zirabev in combination with carboplatin and paclitaxel is 15 mg/kg every 3 weeks for 6 – 8 cycles, followed by a single (Zirabev alone) dose of 15 mg/kg every 3 weeks.

For Recurrent Glioblastoma

The recommended dose of Zirabev for patients with recurrent glioblastoma is 10 mg/kg intravenously every two weeks. 

For Non-squamous, Non-small Cell Lung Cancer

The recommended dose is 15 mg/kg intravenously every three weeks in combination with carboplatin and paclitaxel. 

Zirabev may affect how wounds heal. Because of this, Tôit is recommended not to take the drug before or after surgery for 28 days until your wounds are healed completely. 

How Is Zirabev Given?

Zirabev is only given intravenously. 

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Is Zirabev a Chemotherapy Drug?

No, it is not a chemotherapy drug but an immunotherapeutic drug (an antibody). However, it can be used in combination with chemotherapy drugs to get better results.

Possible Side Effects of Zirabev

Zirabev side effects

Every patient reacts differently while receiving Zirabev IV infusions. Some of the common side effects they may experience during or after infusion includes:

  • Headache, backache
  • Huyết áp cao
  • Inflammation of skin and nose
  • Thay đổi khẩu vị 
  • Watery eyes
  • Bleeding or nose bleeding
  • Da khô
  • Cough, vomiting, or nausea
  • Mất cảm giác thèm ăn

Zirabev also has some severe and potentially fatal side effects which demand immediate medical attention, such as:

  • Gastrointestinal perforation 
  • Hội chứng bệnh não sau hồi phục
  • Suy thận
  • Complications in wound healing
  • Infusion-related reactions causing hypertension, tremors, trouble breathing, and chest pain 
  • Congestive heart failure
  • Arterial thromboembolism
  • Embryo-fetal toxicity
  • Stroke or heart problem
  • Venous thromboembolic events
  • Ovarian failure

Zirabev Precautions

Zirabev therapy is not for everyone. You should consult your healthcare provider before taking Zirabev therapy if you:

  • có thai, as this drug causes embryo-fetal toxicity and can harm your unborn baby. 
  • planning to become pregnant. If you’re receiving Zirabev treatment, then you must use birth control. 
  • đang cho con bú hoặc dự định cho con bú. Since the data on Zirabev secretion in breast milk is limited, avoiding Zirabev is recommended. 
  • Have a previous history of hypertension, heart failure, kidney disease, and diabetes or have undergone surgery recently.

Zirabev Cost 

The cost of Zirabev intravenous with the strength of 100 mg/4 ml (one vial) is about $613.40. For 400 mg/16 ml (one vial), the cost is about $2,453.60. The cost of this medication can vary and depends on the pharmacy you visit. 

TÀI LIỆU THAM KHẢO:

  1. US Food and Drug Administration. Zirabev prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761099s000lbl.pdf
  2. Official Patient Website | ZIRABEVTM (bevacizumab-bvzr) | Safety Info. (n.d.). https://www.zirabev.com/
  3. Zirabev. (2022, July 26). European Medicines Agency. https://www.ema.europa.eu/en/medicines/human/EPAR/zirabev
  4. Dosing Info | ZIRABEVTM (bevacizumab-bvzr) HCP Website | Safety Info. (n.d.). https://zirabev.pfizerpro.com/dosing-and-product-information
  5. Bevacizumab-bvzr (Zirabev) Drug Information. (n.d.). https://www.ucir.org/immunotherapy-drugs/bevacizumab-bvzr
Thông tin này không thay thế cho lời khuyên hoặc phương pháp điều trị y tế. Hãy trao đổi với bác sĩ hoặc nhà cung cấp dịch vụ chăm sóc sức khỏe về tình trạng sức khỏe của bạn trước khi bắt đầu bất kỳ phương pháp điều trị mới nào. AmeriPharma® Specialty Care không chịu bất kỳ trách nhiệm nào đối với thông tin được cung cấp hoặc đối với bất kỳ chẩn đoán hoặc phương pháp điều trị nào được đưa ra do thông tin này, cũng như không chịu trách nhiệm về độ tin cậy của nội dung. AmeriPharma® Specialty Care không vận hành tất cả các trang web/tổ chức được liệt kê ở đây, cũng không chịu trách nhiệm về tính khả dụng hoặc độ tin cậy của nội dung của họ. Các danh sách này không ngụ ý hoặc cấu thành sự chứng thực, tài trợ hoặc khuyến nghị của AmeriPharma® Specialty Care. Trang web này có thể chứa các tham chiếu đến các loại thuốc theo toa có tên thương hiệu là nhãn hiệu hoặc nhãn hiệu đã đăng ký của các nhà sản xuất dược phẩm không liên kết với AmeriPharma® Specialty Care.
Dr. Abdelaziz Alsamarah
ĐÃ ĐƯỢC XEM XÉT Y KHOA BỞI Tiến sĩ Abdelaziz Alsamarah, Dược sĩ, MSPS, BCSCP

Tiến sĩ Alsamarah nhận bằng Tiến sĩ Dược tại Đại học Jordan năm 2011. Để theo đuổi con đường học vấn cao hơn, ông gia nhập Đại học Khoa học Y tế Western, Pomona, California năm 2014 và nhận bằng Thạc sĩ Khoa học Dược phẩm chuyên ngành Thiết kế Thuốc Hỗ trợ Máy tính (CADD). Ông là tác giả và đồng tác giả của một số ấn phẩm trên các tạp chí khoa học lớn. Sau khi tốt nghiệp, Tiến sĩ Alsamarah đã làm việc tại nhiều cơ sở dược phẩm khác nhau trước khi tìm thấy niềm đam mê trong việc quản lý bệnh nhân truyền dịch tĩnh mạch. Các lĩnh vực chuyên môn của ông bao gồm: Bệnh truyền nhiễm, hỗ trợ dinh dưỡng và kháng thể đơn dòng. Trong thời gian rảnh rỗi, ông thích đấm bốc, đạp xe và vẽ tranh cùng ba con.

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