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What is ZirabevTM (bevacizumab-bvzr)?

The United States Food and Drug Administration recently approved an Avastin (bevacizumab) biosimilar, ZirabevTM (bevacizumab-bvzr), manufactured by Pfizer. Like Avastin, ZirabevTM has been approved to treat five different types of cancer: unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer (NSCLC); metastatic colorectal cancer; recurrent glioblastoma; metastatic renal cell carcinoma; and persistent, recurrent or metastatic cervical cancer.1 Depending on the specific type of cancer being treated, ZirabevTM may be used in combination with chemotherapy or as a single therapy.

When used to treat NSCLC, ZirabevTM is given as an intravenous infusion once every three weeks. It is used in combination with the chemotherapeutic drugs carboplatin and paclitaxel.2 ZirabevTM works by slowing the growth of new blood cells by targeting the vascular endothelial growth factor protein.

What is a biosimilar?

Unlike traditional drugs, which are manufactured using a process of adding chemicals in a specific order to make medications, targeted biological agents are made from living cells. While generic drugs can be made by repeating the process that makes traditional medications, manufacturing an exact generic biological agent is impossible.2 Drug manufacturers have worked to create products known as “biosimilars”. These are biological medications that treat conditions the same way, with no meaningful difference, similar to a generic medication. ZirabevTM was tested in approximately 400 patients and found to be no different in treatment outcomes than Avastin.1

Biosimilars work like generic drugs by creating less expensive alternatives, and by creating competition within the drug market to lower prices.2 When medication prices are lowered, more patients can have access to treatments for their diseases.

Does ZirabevTM have side effects?

Like any other medication, ZirabevTM can cause side effects. The most common side effects are:1

  • Nosebleed
  • Headache
  • Increased blood pressure
  • Runny nose
  • Excessive protein in the urine
  • Change in how things taste
  • Dry skin
  • Rectal bleeding
  • Excessive tears in the eyes
  • Back pain
  • Redness or peeling of the skin

These side effects can cause some patients to discontinue treatment. Approximately 10-25% of patients discontinued treatment with ZirabevTM due to side effects.1

Other side effects can occur with ZirabevTM. These side effects can be severe, even fatal. They include:1

  • Infusion-related reactions
  • Blood clots in the lungs, veins, and arteries
  • Stomach perforations
  • Surgery and wound healing complications (patients who have elective surgery while on ZirabevTM should not receive treatment for 28 days prior to and after surgery)
  • Hemorrhage (excessive bleeding)
  • Posterior reversible encephalopathy syndrome (PRES)
  • Congestive heart failure (CHF)
  • Risk of reproductive failure
  • Neutropenia, including neutropenic fever
  • Pneumonitis or lung inflammation

ZirabevTM should not be used by pregnant women as ZirabevTM may cause harm to a developing fetus. Females who can become pregnant should utilize effective birth control (patients should discuss appropriate birth control methods with their doctor) throughout ZirabevTM treatment and for six months following the last dose of ZirabevTM. It is not known whether Zirabev passes into breast milk, and patients should not breastfeed while receiving ZirabevTM treatment and for six months following the last dose of ZirabevTM.

Remember, a physician will only place you on ZirabevTM if they believe that the benefits of being on the medication outweigh the risks of taking the medication. If you experience side effects that interfere with your daily activities, be sure to talk to your doctor. They may be able to prescribe medication to help relieve your side effects or may decide that you may need a different treatment option.

Accessible cancer therapies

ZirabevTM and other biosimilars are paving the way for more accessible cancer therapies. As more biosimilars become available, patients should have greater access to affordable, targeted care that has the opportunity to give them a safer, more effective treatment for multiple cancer diagnoses.

Last reviewed: January 2020.
  1. Pfizer Receives U.S. FDA Approval for Its Oncology Biosimilar, ZIRABEV™ (bevacizumab-bvzr) | Pfizer. Pfizer.com. https://www.pfizer.com/news/press-release/press-release-detail/pfizer_receives_u_s_fda_approval_for_its_oncology_biosimilar_zirabev_bevacizumab_bvzr. Published 2019. Accessed September 1, 2019.
  2. Astor L. FDA Approves Bevacizumab Biosimilar Zirabev. Targeted Oncology. https://www.targetedonc.com/news/fda-approves-bevacizumab-biosimilar-zirabev. Published 2019. Accessed September 1, 2019.
  3. Zirabev (bevacizumab-bvzr) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761099s000lbl.pdf Accessed September 1, 2019.