Aflibercept (Zaltrap ®)
Aflibercept is a targeted (biological) therapy used to treat advanced cancer of the colon or rectum (the large bowel).
Aflibercept is only given to people who have already had treatment with a drug called oxaliplatin. It’s given along with the chemotherapy drugs irinotecan and fluorouracil (5FU) (FOLFIRI). You will find it helpful to read our information about FOLFIRI.
Aflibercept blocks the growth of new blood vessels in the tumour. If the blood supply is reduced, the tumour may shrink or stop growing.
In England, aflibercept is usually available through NHS England’s Cancer Drugs Fund. In Scotland, it is available on the NHS. In Wales, aflibercept is not available on the NHS so it may not be widely used. If you live in Northern Ireland, you can find out from your cancer specialist whether aflibercept is available. We can give you more information on what you can do if a treatment isn’t available where you live.
How aflibercept is givenBack to top
You usually have aflibercept in the chemotherapy day unit. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before, or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy. They will also test your urine and check your blood pressure.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your aflibercept and chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Aflibercept is given with your chemotherapy treatment. The aflibercept is usually given first, followed by the chemotherapy treatment. Your nurse gives you anti-sickness drugs and sometimes a steroid. They give you the drugs and chemotherapy through one of the following:
- a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse gives you aflibercept as a drip (infusion) into your cannula or line over about an hour. They usually run the drip through a pump, which gives you the aflibercept over a set time. You will have the chemotherapy after the aflibercept.
While aflibercept is being given
Some people might have side effects while they are having the treatment:
Aflibercept may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Your course of treatment
Aflibercept, together with chemotherapy, is given as a course of several sessions (or cycles) of treatment over a few months. Each cycle usually takes 14 days (two weeks). At the end of the 14 days, you start your second cycle of treatment. This is the same as the first cycle. Your course of treatment will usually continue as long as it is working. Your doctor or nurse will discuss this with you.
Before you go home, the nurse or pharmacist will give you drugs to take at home. Take all your tablets exactly as explained.
Animations and information you might find helpfulBack to top
Having a central line
This animation is about central lines, how they are fitted and what they are for.
Having a PICC line
This animation is about PICC lines, how they are fitted and what they are for.
Possible side effects of afliberceptBack to top
We explain the most common side effects of aflibercept here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. You will usually have other chemotherapy drugs as well, so you may have other effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, they will start to improve.
Contact the hospital
Your nurse will give you a telephone number or numbers to call the hospital if you feel unwell or need advice any time of day or night. Save these numbers in your mobile phone or keep them somewhere safe.
Risk of infection
Aflibercept in combination with chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5F) or over 38°C (100.4F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
High blood pressure (hypertension)
Your blood pressure may go up, so it should be checked regularly during your treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. High blood pressure can be controlled with tablets prescribed by your doctor. Sometimes the dose of the aflibercept is also reduced. It’s important to tell your doctor before you start your treatment if you take tablets for high blood pressure.
Protein in your urine
Protein may collect in the urine. This can cause your feet to swell. Your urine should be tested regularly for protein during your treatment. Sometimes, your treatment will be delayed for a short time or your drug dose may be lowered.
Blood clot risk
Cancer can increase the chances of a blood clot (thrombosis) in the veins. Aflibercept combined with chemotherapy drugs can add to this risk. A blot clot in the veins can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain.
Aflibercept can sometimes cause a blood clot in the arteries. Signs of this are:
- heaviness or pain in the chest
- numbness in the face, arms or legs
- problems with walking or balance
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Aflibercept can cause bleeding problems. Tell your doctor if you are taking any medicines that may affect bleeding. This includes aspirin, blood thinning tablets such as warfarin, or injections such as heparin, or vitamin E.
Contact your doctor straight away if you notice any of the following:
- blood when you cough
- nose bleeds or bleeding from the gums or vagina
- new or unusual bruising
- black, tar-like bowel motions
- blood in your vomit, or if your vomit looks like coffee grounds.
Occasionally, bleeding can be severe. If you feel very tired, weak or dizzy or have a new tummy pain, contact your emergency number straight away.
This can sometimes be severe when aflibercept is given with irinotecan and 5-fluorouracil. If you get diarrhoea, take the anti-diarrhoea drugs you were given straight away. It’s important to take them exactly as your nurse or pharmacist explained and follow any other advice you were given. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Delayed wound healing
Aflibercept can delay wound healing. If you need an operation, your doctor will stop your treatment four weeks before it. If you have a wound or scar already, it might take longer than usual for it to heal.
Aflibercept can cause a fistula. This is a passageway that develops between two parts of the body, for example the bowel and the skin. A fistula can cause fluid to leak in that area. Tell your doctor or nurse if you notice any leakage of fluid.
You may develop a hoarse voice. Let your doctor know if this happens. They can give you advice on ways to help manage this symptom. It usually gets better after treatment.
Posterior Reversible Encephalopathy Syndrome (PRES)
This is also known as reversible posterior leukoencephalopathy syndrome (RPLS).
Rarely, aflibercept can cause a condition known as PRES or RPLS. The symptoms include confusion, changes in behaviour, sleepiness, fits (seizures) headache, changes in eye sight, and feeling and being sick. If you have these symptoms, let your doctor or nurse know straight away.
It’s important to let your doctor or nurses know straight away if you feel unwell or have severe side effects, including any we don’t mention here. Remember that you may get other side effects that are not listed here if you are having chemotherapy.
Other information about afliberceptBack to top
Some medicines, including ones you buy in a shop or chemist can be harmful when you're having aflibercept. You must tell your doctor if you are taking aspirin, or blood-thinning tablets or injections (such as warfarin and heparin) or vitamin E. Tell them about any other medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Aflibercept can affect your fertility (being able to get pregnant or father a child). If you’re worried about this, it's important to talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for six months after treatment. You can talk to your doctor or nurse about this.
You also need to use a condom if you have sex in the first couple of days of having aflibercept. This is to protect your partner in case there is any of the drug in semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months afterwards. This is in case there is any of the drug in the breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses you're having aflibercept. Tell them the name of your cancer doctor so they can ask for advice.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
The information in this section has been produced in accordance with the following sources and guidelines:
- Aflibercept in the Treatment of Metastatic Colorectal Cancer. Clinical Medicine insights: Oncology 2012:6: 19-30. Published online 2012. January 4 doi: 10.4137/CMO.S7432.
- British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. 65th edition. 2013.
- Current and Novel Treatment Options for Metastatic Colorectal Cancer: Emphasis on Aflibercept. Biological Therapy. 2013. 3:25-33 DOI 10.1007/s13554-013-0009-6.
- Electronic Medicines Compendium (eMC) (accessed December 2013).
- Micromedex ® (accessed July 2013).
- National Institute for Health and Care Excellence (NICE) Colorectal cancer (metastatic) - aflibercept: appraisal consultation document. 2013 (accessed July 2013).
- Scottish Medicines Consortium (SMC). Aflibercept (Zaltrap) (accessed April 2014).
If you’d like further information on the sources we use, please feel free to contact us.
With thanks to: Dr Michael Braun, Consultant in Medical Oncology; Christine Clarke, Macmillan Specialist Oncology Pharmacist; Dr Timothy Iveson, Consultant Medical Oncologist: Dr Antonio Saha, Consultant in Medical Oncology; Dr Daniel Swinson, Consultant in Non-Surgical Oncology; and the people affected by cancer who reviewed this edition.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to develop. You could help us too when you join our Cancer Voices Network – find out more.