Zirabev
Zirabev (bevacizumab or bevacizumab-bvzr) is a targeted anticancer treatment for several types of cancers, including cervical cancer, colorectal cancer, and glioblastoma. It's one of the biosimilars to Avastin (bevacizumab). Zirabev (bevacizumab) is infused into the vein (IV) by your healthcare provider, typically once every 2 to 3 weeks. Some of the more common side effects of this medication include diarrhea and weakness. Zirabev (bevacizumab) can also cause rare, but serious side effects, like bleeding and tears in the gut.
What is Zirabev (bevacizumab)?
What is Zirabev (bevacizumab) used for?
Metastatic, recurrent, or persistent cervical cancer
Metastatic colorectal cancer
Recurrent glioblastoma
Non-squamous non-small cell lung cancer
Ovarian, fallopian tube, or primary peritoneal cancer
Metastatic renal cell carcinoma
How Zirabev (bevacizumab) works
Zirabev (bevacizumab) is a targeted therapy anticancer medication known as a vascular endothelial growth factor (VEGF) inhibitor. VEGF is a specific protein that helps cancer cells grow by promoting and expanding their blood supply. Zirabev (bevacizumab) works by blocking VEGF. This cuts off cancer’s blood supply, helping slow down its growth.
Drug Facts
What are the side effects of Zirabev (bevacizumab)?
Common Side Effects
- Nose bleeds
- Headache
- High blood pressure
- Runny nose
- Higher levels of protein in urine test
- Changes in taste
- Dry skin
- Bleeding that’s difficult to stop
- Dry eyes or watery eyes
- Back pain
- Peeling or blistering skin
Serious Side Effects
- Tears in the gut: fever, chills, intense stomach pain or cramps, bloating
- Fistulas: skin irritation around the anus, discharge from the anus, swelling or redness around the anus, blood in the stool
- Serious bleeding (general): unusual bleeding, bleeding that’s difficult to stop, easy bruising, blood in urine or stool
- Bleeding in the lungs: Chest pain, cough, trouble breathing, wheezing, fast heartbeat
- Stomach bleeds: tiredness, vomiting blood, stomach cramps, black or tarry stool, blood in the stool
- Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
- Blood clot in the lungs: cough, chest pain, trouble breathing, racing heart
- Blood clot in the heart: chest pain, stomach discomfort, sweating, nausea, dizziness
- Blood clot in the leg: leg cramp, swelling, pain, muscle tightness
- Dangerously high blood pressure: anxiety, blurry vision, confusion, chest pain, nausea, vomiting, headache
- Serious kidney problems: trouble thinking clearly, nausea, vomiting, feeling very tired, urinating less than usual
- Serious infusion reactions: trouble breathing, itching or hives, flushing, swelling, chest pain, fast heartbeat, dizziness, fainting
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Black, tarry stools
bleeding gums
body aches or pain
burning, tingling, numbness, or pain in the hands, arms, feet, or legs
chest pain, discomfort, or tightness
chills
cloudy urine
cracks in the skin
decreased urine output
difficult or labored breathing
dilated neck veins
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
ear congestion
irregular breathing
irregular heartbeat
lack or loss of strength
lightheadedness
loss of appetite
loss of heat from the body
loss of voice
mood changes
nervousness
pain, redness, or swelling in the arm or leg
painful or difficult urination
pinpoint red spots on the skin
pounding in the ears
rapid breathing
redness of the skin
runny or stuffy nose
seizures
sensation of pins and needles
slow or fast heartbeat
sores on the skin
sores, ulcers, or white spots on the lips or in the mouth
stabbing pain
sunken eyes
sweating
swelling of the face, fingers, feet, or lower legs
swelling or inflammation of the mouth
swollen glands
thirst
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
vomiting of blood or material that looks like coffee grounds
watery or bloody diarrhea
wrinkled skin
yellow skin
Less common
Bone pain
difficulty with swallowing
fainting
severe constipation
severe vomiting
stomach pain or tenderness
Rare
Back pain
blisters
blurred vision
confusion
dizziness
drowsiness
headache
increased thirst
loss of consciousness
muscle pain or cramps
open sores
pale skin
Incidence not known
Bloody mucus or unexplained nosebleeds
heavy jaw feeling
high fever
hoarseness
indigestion
loosening of a tooth
pain, swelling, or numbness in the mouth or jaw
stomach cramping or burning
stomach pain, usually after eating a meal
sudden weakness in the arms or legs
sudden, severe chest pain
unexplained bleeding or bruising
unusual tiredness or weakness
voice changes
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Belching
bloody nose
change in taste or bad unusual or unpleasant (after) taste
change in walking and balance
clumsiness or unsteadiness
excess flow of tears
stomach discomfort or upset
thinning of the hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Zirabev (bevacizumab)
Pros
Treats many cancer conditions
A alternative option to Avastin (bevacizumab)
Short infusion times (typically only 30 minutes, after the first two treatments)
Typically only infused once or twice a month
Cons
Can cause side effects such as high blood pressure, blood clots, and bleeding
Can trigger an infusion reaction, which can be serious
Not recommended during pregnancy or breastfeeding
Might need to stop treatment a month in advance if you need to have surgery
Pharmacist tips for Zirabev (bevacizumab)
Although rare, you might experience a reaction during or shortly after your Zirabev (bevacizumab) infusion, which can be life-threatening. Let your provider know or get help right away if you experience any infusion reactions like trouble breathing, hives, flushing, chest pain, skin turning blue, fast heartbeat, or dizziness.
Zirabev (bevacizumab) can raise your blood pressure. You should monitor your blood pressure at least once every 2 to 3 weeks while receiving Zirabev (bevacizumab). If you develop high blood pressure while receiving Zirabev (bevacizumab), your healthcare provider may prescribe blood pressure medications to help lower your blood pressure.
You should let your healthcare provider know if you are planning to have surgery. Because Zirabev (bevacizumab) can slow wound healing, your provider might need to stop your infusions a month before or after surgery and until surgical wounds are fully healed.
Zirabev (bevacizumab) can cause higher levels of protein in your urine. This might lead you to urinate more often or your urine to look darker or more cloudy. Let your healthcare provider know if you have changes in your urine as they might need to order lab tests to check your kidney health.
Zirabev (bevacizumab) can cause you to bruise or bleed more easily. To lower your risk of bleeding, you should consider using a soft bristle toothbrush so that it’s more gentle on your gums. Also, consider using an electric razor so you’re less likely to get nicks or cuts while shaving. Take precaution to avoid getting injured. Tell your healthcare provider right away if you notice any unusual bleeding or bleeding that takes a long time to stop or gets worse over time.
Receiving Zirabev (bevacizumab) treatment might impact your ability to have children (fertility) if you are a female. If you have concerns or questions about this, talk with your provider before you start treatment.
You shouldn't receive Zirabev (bevacizumab) while pregnant due to the risk of harm to an unborn baby. If you are able to become pregnant, you should use birth control, like condoms or birth control pills, while on treatment and for at least 6 months after your last dose. Let your healthcare provider know if you become pregnant.
Frequently asked questions about Zirabev (bevacizumab)
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What are the risks and warnings for Zirabev (bevacizumab)?
Zirabev (bevacizumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Injury in the gut and fistulas
Risk factors: History of pelvic radiation | Receiving Zirabev (bevacizumab) for cervical cancer
Though not common, some people who took Zirabev (bevacizumab) have developed tears in their gut and fistulas (an abnormal connection from one part of the body to another). These problems are serious and can sometimes even be life-threatening. Gut injuries and fistulas are more likely to happen for people who’ve had radiation around the pelvic region or people with cervical cancer. Most gut tears appeared within 2 months of the first dose of Zirabev (bevacizumab). And most fistulae develop within 6 months of the first dose. Let your provider know if you have symptoms of gut injuries or fistulas, such as high fever, shivering, vomiting, a lot of stomach pain (especially if it doesn’t go away), pain in the anal area, or severe constipation.
Surgery and wound healing problems
Zirabev (bevacizumab) can make it more difficult for your wound to heal. Let your provider know if you’re planning to have a surgery or procedure. You shouldn’t receive Zirabev (bevacizumab) a month before and after surgery, and until surgical wounds have fully healed.
In addition, if you get injured while receiving Zirabev (bevacizumab) and your wounds are healing very slowly, let your provider know. Your provider might ask you to temporarily stop this medication until your injuries have healed.
Serious bleeding
Zirabev (bevacizumab) can raise the risk of serious bleeding. Bleeding can happen in any area of the body, including in the lungs, stomach, and brain.
Let your healthcare provider know immediately if you experience any serious or unusual bleeding, especially bleeding that’s difficult to stop. Get medical help right away if you feel nauseous, have a sudden or painful headache, feel nauseous, notice a change in your vision, have stomach pain, or are coughing or spitting up blood.
Serious blood clots
Risk factors: History of blood clots | High cholesterol | Smoking | High blood pressure | Older adult
Zirabev (bevacizumab) can raise your risk for blood clots in your body, including stroke and heart attack. Sometimes, blood clots can be life-threatening. You might be at a higher risk for clots while taking Zirabev (bevacizumab) if you’ve had blood clots in the past, have high cholesterol, smoke, or have high blood pressure. Symptoms of a blood clot might be different depending on the location of the clot. They can include trouble walking, blurry vision, breathing problems, chest pain, and swelling in the leg. Get medical attention right away if you have any of these symptoms.
High blood pressure
Zirabev (bevacizumab) can raise your blood pressure. Your provider will ask you to monitor your blood pressure at least once every 2 to 3 weeks while you’re receiving treatment. If your blood pressure starts to rise, your provider might ask you to start blood pressure-lowering medications for you. If your blood pressure isn’t well-controlled by medication, your provider will likely ask you to stop Zirabev (bevacizumab) until they find a treatment that can bring your blood pressure down to a safe level. If your blood pressure becomes dangerously high, your provider will likely ask you to switch to a different medication. Let your provider know if you notice symptoms of high blood pressure, such as dizziness, tiredness, and headaches.
Posterior reversible encephalopathy syndrome (PRES)
Posterior reversible encephalopathy syndrome (PRES) is a very rare side effect of Zirabev (bevacizumab). Let your provider know if you have any symptoms of PRES, like headache, feeling sluggish, confusion, and blindness.
Symptoms can appear anytime during Zirabev (bevacizumab) treatment, ranging from within a day of to a year after your first dose.
If you develop symptoms, your provider will likely check whether or not you have PRES by ordering a brain scan called a magnetic resonance imaging (MRI). If you do have PRES, then it’s very likely that your provider will ask you to stop Zirabev (bevacizumab) treatment. Typically, symptoms of PRES go away within days after you stop this medication.
Kidney problems
Zirabev (bevacizumab) raises the risk of kidney problems, which can be serious. In clinical trials, people developed kidney problems anywhere from within 2 weeks to about 3 years after starting this medication. Your provider will regularly monitor your kidney health through lab work and taking urine samples while you’re receiving this medication. If you develop kidney problems, your provider might pause Zirabev (bevacizumab) until your kidney condition gets better. Talk to your provider if you notice any changes in how often you urinate (more or less) or any blood in your urine so they can check for kidney problems.
Infusion-related reactions
Some people have experienced very serious reactions from the IV infusions of Zirabev (bevacizumab). These reactions can occur during or even several hours after the infusion. Symptoms can include chest pain, headaches, trouble breathing, and confusion.
If you do have a reaction, your care team might slow down or stop the infusion and treat you with medications, such as corticosteroids or antihistamines, to ease your symptoms. If your reaction isn't too severe, your care team might restart Zirabev (bevacizumab) infusion at a slower rate. But if you have a serious reaction, then your provider might switch you to a different medication.
Harm to an unborn baby
Based on animal studies, it’s possible that Zirabev (bevacizumab) can cause side effects if received by mothers during pregnancy. If you’re a female who can get pregnant, your provider will ask you to use birth control while receiving Zirabev (bevacizumab) and for 6 months after the last dose. Let your provider know right away if you become pregnant during this time.
Possible risk of fertility problems (for females)
Though more research is needed, there’s a possibility that Zirabev (bevacizumab) might affect your ability to have a child (for females). If you’re a female who’s considering having children in the future, talk with your healthcare provider about possible options for egg freezing before starting treatment with Zirabev (bevacizumab).
Heart problems
Risk factors: History of treatment anthracycline-based chemotherapy
Make sure your provider is aware of all the anticancer medications you’ve received in the past. Zirabev (bevacizumab) can raise the risk of developing heart failure for people who have received anthracycline-based chemotherapy, such as doxorubicin, in the past. This means your heart might become too weak to pump blood to other parts of your body, and you can experience symptoms such as trouble breathing, swelling in the legs or feet, or sudden weight gain. If you’ve received an anthracycline-based chemotherapy in the past, make sure your current provider is aware. They might decide to not treat you with Zirabev (bevacizumab) to avoid the risk of heart failure.
Zirabev (bevacizumab) dosage forms
Typical dosing for Zirabev (bevacizumab)
Zirabev (bevacizumab) is infused into the veins (IV) by a healthcare provider. Your provider will determine the right dose based on your body weight.
The typical dose of Zirabev (bevacizumab) ranges from 5 mg/kg to 15 mg/kg infused IV once every 2 to 3 weeks.
Your exact dose and how often you’ll get the infusion also depends on the type of cancer you have and what other anticancer medications your provider prescribes.
Interactions between Zirabev (bevacizumab) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Tofacitinib
What are alternatives to Zirabev (bevacizumab)?
Metastatic, recurrent, or persistent cervical cancer
Metastatic colorectal cancer
Recurrent glioblastoma
Non-squamous non-small cell lung cancer
Ovarian, fallopian tube, or primary peritoneal cancer
Metastatic renal cell carcinoma
Metastatic, recurrent, or persistent cervical cancer
Metastatic colorectal cancer
Recurrent glioblastoma (a type of brain tumor)
Metastatic or unresectable hepatocellular carcinoma (liver cancer)
Nonsquamous non-small cell lung cancer
Ovarian, fallopian tube, or primary peritoneal cancer
Metastatic renal cell carcinoma (kidney cancer)
Metastatic, recurrent, or persistent cervical cancer
Metastatic colorectal cancer
Recurrent glioblastoma
Non-squamous non-small cell lung cancer
Ovarian, fallopian tube, or primary peritoneal cancer
Metastatic renal cell carcinoma
What is the latest news about Zirabev (bevacizumab)?
Zirabev (bevacizumab) images
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References
Best studies we foundAmerican Brain Tumor Association. (2022). Glioblastoma (GBM).
Clemmons, A., et al. (2021). Premedications for cancer therapies: A primer for the hematology/oncology provider. Journal of the Advanced Practitioner in Oncology.
Kazazi-Hyseni, F., et al. (2010). Bevacizumab. The Oncologist.
Levy, S. (2022). Celltrion USA obtains FDA OK for Avastin biosimilar. Drug Store News.
MedlinePlus. (2023). Fistula.
National Cancer Institute. (n.d.). Posterior reversible encephalopathy syndrome.
National Cancer Institute. (n.d.). Recurrent cancer.
National Cancer Institute. (n.d.). VEGF.
National Cancer Institute. (2020). Metastatic cancer: When cancer spreads.
National Cancer Institute. (2022). Targeted therapy to treat cancer.
National Cancer Institute. (2023). What is cervical cancer?
Pfizer Laboratories Div Pfizer Inc. (2023). Zirabev- bevacizumab-bvzr injection, solution [package insert]. DailyMed.
Shen, S., et al. (2020). Persistent cancer cells: The deadly survivors. Cell.
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