Aflibercept (Zaltrap)

Aflibercept (pronounced ay-flib-er-set) is a targeted cancer drug and is also known by its brand name, Zaltrap.

It is a treatment for advanced bowel cancer.

You usually have it together with the chemotherapy combination FOLFIRI. And only if you have already had the chemotherapy drug oxaliplatin. 

How it works

Aflibercept works by stopping cancer cells from making new blood vessels. This is called anti angiogenesis treatment. 

All cells, including cancer cells, need to develop new blood vessels so that they can grow. Aflibercept blocks 3 proteins that cells need to develop blood vessels. So the cancer can't grow. 

How you have it

You have aflibercept into your bloodstream (intravenously). 

Drugs into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You have aflibercept every 2 weeks for as long as it is working. It takes 1 hour each time. If you are having it with other chemotherapy, you usually have aflibercept first. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

Each of these effects happens in more than 10 out of 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Protein in urine

Small amounts of protein in your urine may be found when your nurse tests your urine. This is not usually a problem and goes away on its own. If there are large amounts of protein you may have tests to check how well your kidneys are working.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Voice changes 

Talk to the team looking after you about this. 

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Redness and peeling on hands and soles of foot

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Kidney changes 

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

Occasional side effects

Each of these effects happens in between 1 and 10 out of 100 people (between 1 and 10%). You might have one or more of them. They include:

  • blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening alert your nurse or doctor if notice any of these symptoms
  • an abnormal opening between parts of the body (fistula)
  • toothache
  • skin colour changes
  • infection of your water works (urinary tract infection) - symptoms might include it being painful and hard to pass urine, you might have an urgency or want to go more often. Or your urine might smell or look cloudy
  • common cold causing symptoms such as blocked or runny nose, sore throat, headaches, cough, sneezing, muscle aches and high temperature
  • lack of fluid in the body (dehydration)
  • pain in the throat
  • haemorrhoids, bleeding, spasm or pain in your back passage (anus)
  • heart failure and changes in how the heart muscle is working (low ejection fraction)

Rare side effects

Each of these effects happens in fewer than 1 out of 100 people (fewer than 1%). You might have one or more of them. They include:

  • tear in the bowel wall (perforation)
  • damage to the jaw bone
  • slow wound healing
  • a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away, this condition is reversible

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Related links