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Patient Brochure

YOUR INTRODUCTION TO ZIRABEV® (bevacizumab)

The ZIRABEV patient brochure is also available in the following languages:

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Getting started on my ZIRABEV treatment

Learning about a new treatment can be a challenge. This site has been designed to answer some of the questions you may have and help you better understand what ZIRABEV is and how it works.
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Also, be honest with yourself and your healthcare team about how you’re doing, and speak to them when you have any questions or concerns about your treatment plan.

What is ZIRABEV used for?

ZIRABEV is a treatment option for patients with 1 of the following:

Metastatic colorectal cancer:
ZIRABEV is used in combination with a specific type of chemotherapy (intravenous
5-fluorouracil [5-FU]-based chemotherapy) for treatment of people diagnosed with metastatic colorectal cancer for the first time. Metastatic colorectal cancer is cancer of the colon or rectum that has spread to other organs in the body.

Metastatic lung cancer:
ZIRABEV is used in combination with a specific type of chemotherapy (carboplatin and paclitaxel) for the treatment of people diagnosed with metastatic non-small cell lung cancer. Metastatic non-small cell lung cancer is cancer of the lungs that has spread to other organs in the body.

Recurrent platinum-sensitive ovarian cancer:
ZIRABEV is used in combination with a specific type of chemotherapy (carboplatin and gemcitabine) for the treatment of people diagnosed with recurrent, platinum-sensitive, epithelial ovarian, fallopian tube or primary peritoneal cancer that comes back at least 6 months after the last time the patient responded to a chemotherapy regimen containing a platinum agent. Epithelial ovarian cancer is cancer that develops on the surface of the ovary. Fallopian tube cancer is cancer that forms in the fallopian tubes, the small ducts that link the ovaries to the uterus. Primary peritoneal cancer is cancer of the tissue that lines the abdominal wall and covers organs in the abdomen.

Recurrent platinum-resistant ovarian cancer:
ZIRABEV is used in combination with a specific type of chemotherapy (paclitaxel, topotecan or pegylated liposomal doxorubicin) for the treatment of people diagnosed with recurrent, platinum-resistant, epithelial ovarian, fallopian tube or primary peritoneal cancer who received no more than two prior chemotherapy regimens. Recurrent platinum-resistant ovarian cancer is the type of cancer that progresses within 6 months after the last time the patient responded to a chemotherapy regimen containing a platinum agent.

Recurrent glioblastoma:
ZIRABEV is used in combination with lomustine (a specific type of chemotherapy) for the treatment of patients with a particular type of brain cancer called glioblastoma in which the cancer reoccurred after a previous treatment.

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How does ZIRABEV work?

ZIRABEV is not chemotherapy. ZIRABEV is a monoclonal antibody that is given in combination with a specific type of chemotherapy. While chemotherapy attacks the tumour directly, ZIRABEV attacks the blood vessels that surround the tumour.

In order to grow and spread, tumours need a constant supply of oxygen and other nutrients. Tumours get this supply by creating their own network of blood vessels. This process is called angiogenesis (an’-gee-o-jen’-i-sis). ZIRABEV works by blocking angiogenesis. By preventing the growth of new blood vessels, ZIRABEV helps starve the tumour of oxygen and other nutrients. This makes it hard for the tumour to grow.

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What formats are available for ZIRABEV?

ZIRABEV is available as solution for infusion in single-use vials in the presentations listed below: 

  • • 100 mg/4 mL (25 mg/mL)
  • • 400 mg/16 mL (25 mg/mL) ​​​​​

​​​​​​​The vial stopper is not manufactured with natural rubber latex.​​​​​​​​​​

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How will I receive ZIRABEV?

ZIRABEV is given intravenously (through a needle placed in a vein in the arm, hand, or through a central line).

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How often will I receive ZIRABEV?

Depending on your specific type of cancer, you may receive ZIRABEV every 2 to 3 weeks with or without additional treatment. 

Metastatic colorectal cancer: the usual dose is based on your weight in kg (5 mg/kg) and is given once every 14 days for as long as your physician recommends therapy.

Metastatic lung cancer: the usual dose is based on your weight in kg (15 mg/kg) and on the specific type of chemotherapy given along with ZIRABEV. ZIRABEV is given once every 3 weeks for as long as your physician recommends therapy.

Ovarian cancer (platinum-sensitive recurrent disease): the usual dose of ZIRABEV is based on your weight in kg (15 mg/kg). ZIRABEV is given once every 3 weeks for as long as your physician recommends therapy. 

Ovarian cancer (platinum-resistant recurrent disease): the usual dose is based on your weight in kg (10 mg/kg or 15 mg/kg) and is given once every 2 or 3 weeks for as long as your physician recommends therapy (your doctor will prescribe a dose and schedule of ZIRABEV that is right for you, based on if and what type of chemotherapy you are receiving). 

Recurrent glioblastoma: the usual dose is based on your weight in kg (10 mg/kg) and is given once every 2 weeks in combination with lomustine every 6 weeks for as long as your physician recommends therapy. The dose of lomustine in the first treatment is 90 mg per square metre of your body surface area (mg/m2 ), up to a maximum dose of 160 mg. It can be increased to 110 mg/m2 , up to a maximum of 200 mg, from the second treatment onwards. The increased dose of lomustine after the first treatment will be determined by your doctor based on your blood work. 

The first time ZIRABEV is given, the infusion will take about 90 minutes. 

Once your doctor has made sure that you have no problems with the ZIRABEV infusions, (i.e., after the first or second infusion) the following infusions after that may require less time, usually about 30 or 60 minutes. 

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Preparing for my next appointment 

It’s important to ask questions and let your healthcare team know if you have any concerns about your treatment. 

​​​​​​​It’s always good to keep a notebook handy so you can write down any questions or concerns that you would like to talk to your healthcare team about.

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Support may help

Support may help you navigate your treatment experience. If you’d like to join a support group, ask your healthcare team if there’s one in your area.

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Pfizer Liaison Patient Support Program 

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Additional resources

Canadian Cancer Society
The Canadian Cancer Society (CCS) is a national, community-based organization that provides information and support services to patients and families affected by cancer.

The CCS online community – Cancerconnection.ca – is a place where patients and families affected by cancer can share their experiences and build supportive relationships. No matter where you are, you can connect with others online and know that you are not alone.

Visit www.cancerconnection.ca or www.cancer.ca, or call 1-888-939-3333.

Colorectal Cancer Association of Canada
The Colorectal Cancer Association of Canada is a national non-profit organization with a threefold mandate: awareness, support, and advocacy.

Visit www.colorectalcancercanada.com or call 1-877-502-6566.

Lung Cancer Canada
Lung Cancer Canada is a national charitable organization and leader in resources for lung cancer education, patient support, research, and advocacy.

Visit www.lungcancercanada.ca or call 1-888-445-4403.

Ovarian Cancer Canada
Ovarian Cancer Canada is a Canadian organization providing leadership in research, advocacy, and support for women with ovarian cancer.

Visit www.ovariancanada.org or call 1-877-413-7970.

Brain Tumours Foundation of Canada
The Brain Tumours Foundation of Canada is a dedicated team of volunteers, patients, survivors, family members, healthcare professionals and staff, determined to help brain cancer patients along their journey.

Visit www.braintumour.ca or call 1-800-265-5106.

The suggested resources on this page do not imply an endorsement of or an association with third-party organizations and are provided for information purposes only. Pfizer is not responsible for content of non-Pfizer sites.

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Safety Information  +

Privacy Policy

Terms of Use

This website is intended for patients who are taking ZIRABEV®.

ZIRABEV® is a registered trademark of Pfizer Inc. Used under license.

© 2023 Pfizer Canada ULC, Kirkland, Québec H9J 2M5

PP-ZIR-CAN-0022-EN 

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Important Safety Information

What should I know before I take ZIRABEV?

Do not use ZIRABEV if you:

  • are allergic to it or any of its ingredients
  • have a cancer that has spread to your central nervous system (to your brain or spine)
  • had surgery within the past 28 days

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take ZIRABEV.

Talk about any health conditions or problems you may have, including if you:

  • have high blood pressure
  • plan to have surgery or have had surgery in the last 28 days
  • have ever had a heart attack or stroke
  • are pregnant or planning to become pregnant
  • are breastfeeding 
  • have any allergies to this drug or its ingredients 
  • have any illnesses or diseases affecting your kidneys
  • have heart failure or weakened heart muscles
  • have ever coughed up blood or observed abnormal vaginal bleeding
  • are diabetic

What are possible side effects of ZIRABEV?

These are not all the possible side effects that you may feel when taking ZIRABEV. If you experience any side effects not listed here, contact your healthcare professional.

Like all medications, ZIRABEV can cause some unwanted side effects. The following side effects were seen in clinical trials when ZIRABEV in combination with chemotherapy or ZIRABEV alone was given to patients:

Very Common (more than 1 in 10 patients):

  • High blood pressure
  • Diarrhea or vomiting
  • Abdominal pain
  • Constipation
  • Nausea
  • Lack of energy or strength
  • Loss of appetite
  • Pain (including joint pain)
  • Bleeding (from the nose or rectum)
  • Sores in the mouth
  • Shortness of breath
  • Runny nose
  • Dry, scaling skin or changes in skin colour
  • Changes in the sense of taste
  • Eye problems (for example: excessive tearing, blurred vision, or an experience of discomfort or pain to the eyes due to light exposure)
  • A decrease in certain white blood cells in the blood that help fight off infection
  • A decrease in the number of red blood cells (anemia)
  • Difficulty sleeping
  • Fever, chills, or excessive sweating
  • Headache
  • Abnormal urine test (protein in the urine)
  • Tingling sensation or numbness in toes and fingers
  • Bronchitis (an inflammation of the main air passages to the lungs)
  • Bruising
  • Change in moods
  • Infections (mouth, throat, sinus, lungs, or urine infections)
  • Excess of sugar in the blood
  • Weight loss
  • Widening of the blood vessels
  • Low levels of sodium and magnesium in the blood
  • Coughing
  • Tiredness

Common (fewer than 1 in 10 patients but more than 1 in 100 patients):

  • Pain (including muscle pain, chest pain, heart pain [angina], back pain, and pain in the pelvis and anal regions)
  • Stroke/heart attack
  • Blood clots
  • Perforation of the gut (hole in the stomach or bowel)
  • Altered voice, such as hoarseness
  • Swelling and numbness of the hands and feet
  • Urinary (bladder or kidney) infection
  • Infections of the skin or deeper layers under the skin
  • Fistula (abnormal tube-like connection between internal parts of the body that are not normally connected), such as between the stomach and intestines (gastrointestinal fistula), in patients with metastatic colorectal cancer and recurrent ovarian cancer, and between the vagina and the gut in patients with cervical cancer (unauthorized use)
  • Allergic reactions
  • Nephrotic syndrome (a type of kidney disorder)

Uncommon (fewer than 1 in 100 patients but more than 1 in 1000 patients):

  • Non-gastrointestinal perforations and fistulae (abnormal holes or tubes in areas of the body other than the gastrointestinal tract)
  • Posterior Reversible Encephalopathy Syndrome (PRES), a syndrome characterized by headache, confusion, seizures and visual loss

Rare (fewer than 1 in 1000 patients but more than 1 in 10,000 patients):

  • Tracheoesophageal fistula (abnormal tube-like connection between internal parts of the body that are not normally connected), which is between the trachea (or windpipe) and esophagus (tube connecting the mouth to the stomach)
  • Severe bacterial infection of the skin and soft tissue (necrotizing fasciitis)
  • Bleeding (in the brain)

Frequency unknown:

  • Ulcers in the stomach and bowel
  • Jawbone damage resulting from poor blood supply to the jawbone
  • Perforation in the gallbladder (hole in the digestive organ that stores bile)

If your blood pressure increases while you are taking ZIRABEV, it is important to contact your doctor.

Changes in your blood and urine tests done by your doctor may occur while you are receiving ZIRABEV. These changes may include a lower white cell count and protein in the urine. Your doctor will discuss these results with you.

Elderly patients (65 years or older) have a greater risk of developing the following side effects: blood clots (that may lead to stroke or heart attack), a decrease in certain white blood cells and platelets, protein in the urine, diarrhea, and fatigue.

Stop taking ZIRABEV right away and get medical help if you experience any of the following serious side effects.

Very common (more than 1 in 10 patients):

  • Bleeding from the nose that lasts for more than 10–15 minutes and cannot be stopped

Common (fewer than 1 in 10 patients but more than 1 in 100 patients):

  • Perforation of the gut (leakage of the bowel); symptoms include sudden onset of abdominal pain, and abdominal tenderness with vomiting and high fever
  • Stroke or heart attack; symptoms of stroke include sudden loss of speech or numbness of part or all of the body, loss of vision or blurred vision, unexplained dizziness and/or sudden falls; symptoms of a heart attack include chest pain with spreading to the left arm, jaw and/or back, and shortness of breath
  • Fistula, which is an abnormal tube-like connection between internal organs and skin or other tissues that are not normally connected, including connections between the vagina and the gut in patients with cervical cancer (unauthorized use)

Uncommon (fewer than 1 in 100 patients but more than 1 in 1000 patients):

  • Non-gastrointestinal perforations and fistulae; depending on the organs involved, the symptoms could be as follows: leakage of urine, abnormal and bad odour in the genital area, abdominal pain, vomiting, fever, gradually increasing/worsening of shortness of breath (dyspnoea), cough, chest pain, yellowish discolouration of the skin, etc.
  • Posterior Reversible Encephalopathy Syndrome (PRES); symptoms include headache, confusion, seizures and visual loss

If you have a troublesome symptom or side effect that is not listed here or if it becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

Serious warnings and precautions

Be sure to contact your healthcare team if there are any signs of these side effects:

EYE DISORDERS

EYE DISORDERS
ZIRABEV was not developed to be injected in the eye and should be used as authorized. Side effects affecting the eye and the body as a whole were seen in some patients who had bevacizumab injected in one or both of their eyes.

GASTROINTESTINAL PERFORATIONS

GASTROINTESTINAL PERFORATIONS
ZIRABEV treatment can cause gastrointestinal perforation (a hole in the stomach or bowel), which can be fatal. ZIRABEV treatment should be stopped if this happens. Gastrointestinal perforation can happen at any time during treatment. Symptoms include abdominal pain, constipation, and vomiting.

WOUND HEALING COMPLICATIONS

WOUND HEALING COMPLICATIONS
ZIRABEV treatment can cause wound dehiscence (wounds opening and not healing), which can be fatal. ZIRABEV treatment should be stopped if this happens and for one month after having surgery or until the wound is fully healed. ZIRABEV should be stopped at least 28 days before elective surgery.

HEMORRHAGE (BLEEDING)

HEMORRHAGE (BLEEDING)
Treatment with ZIRABEV can result in serious or fatal bleeding, including coughing up blood, bleeding in the stomach, vomiting of blood, bleeding in the brain, nosebleeds, and vaginal bleeding. These events occurred up to 5 times more often in people who received bevacizumab compared to patients who received only chemotherapy. People who have recently coughed up blood (greater than or equal to a half teaspoon of red blood) or have serious bleeding should not receive ZIRABEV. Treatment with ZIRABEV should be permanently stopped if serious bleeding occurs (i.e., requiring medical attention).