About ZIRABEV™ Infusion Therapy
ZIRABEV™ (bevacizumab-bvzr) is a biologic medication known as a VEGF inhibitor, given as an intravenous (IV) infusion. Rather than working through the immune system, it targets the tumor's blood supply, blocking the signal tumors use to build new blood vessels and cutting off the oxygen and nutrients they need to keep growing and spreading.
ZIRABEV™ is FDA-approved as a biosimilar to AVASTIN®. A biosimilar is a biologic medicine that is highly similar to an already approved reference product, with no clinically meaningful differences in safety, purity, or potency. Biosimilars often help make treatment more affordable, and your insurance plan may prefer one bevacizumab product over another.
Dosing is weight-based and set by your diagnosis and the chemotherapy it is paired with, ranging from 5 mg/kg or 10 mg/kg every two weeks to 15 mg/kg every three weeks. Your first infusion runs over about 90 minutes. If you tolerate it well, the second is given over 60 minutes and later infusions over 30.
Because ZIRABEV™ slows wound healing, treatment is held for at least 28 days before planned surgery and is not restarted for at least 28 days afterward, once the wound has fully healed.
Conditions treated by this therapy
ZIRABEV™ is approved to treat several types of cancer in adults, including:
- Metastatic colorectal cancer, first- or second-line, with intravenous fluorouracil-based chemotherapy
- Metastatic colorectal cancer, second-line, with fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin chemotherapy, for patients who have progressed on a first-line regimen that included a bevacizumab product
- Unresectable, locally advanced, recurrent, or metastatic non-squamous non-small cell lung cancer, first-line, with carboplatin and paclitaxel
- Recurrent glioblastoma
- Metastatic renal cell carcinoma, with interferon alfa
- Persistent, recurrent, or metastatic cervical cancer, with paclitaxel and cisplatin or paclitaxel and topotecan
- Stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgery, with carboplatin and paclitaxel, then ZIRABEV™ on its own
- Platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who have had no more than two prior chemotherapy regimens, with paclitaxel, pegylated liposomal doxorubicin, or topotecan
- Platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer, with carboplatin and paclitaxel or carboplatin and gemcitabine, then ZIRABEV™ on its own
Two limits are worth knowing. ZIRABEV™ is not indicated for the adjuvant treatment of colon cancer, and unlike AVASTIN®, it is not approved for hepatocellular carcinoma in combination with atezolizumab. A referral written for bevacizumab in that liver cancer setting cannot be filled with this product.
Your oncologist will confirm whether ZIRABEV™ is right for you before treatment begins.
ZIRABEV™ Price
The cost of prescription medications can vary depending on your insurance coverage. If you're concerned about the price of your medication:
- Contact your insurance provider to understand your coverage
- Ask your doctor or pharmacist about lower-cost alternatives
- Check with the drug manufacturer about financial assistance programs
- Explore patient assistance options if you're uninsured or underinsured
Remember, many resources exist to help patients access necessary medications. Don't hesitate to ask for help if you're struggling with medication costs. No patient should go without necessary treatment due to financial limitations. If you have questions about financial assistance opportunities, contact a member of our Violet Health team.
What to Expect During ZIRABEV™ Infusion Therapy
When you arrive at your Violet Health location, a member of our team greets you and helps you settle into a private, welcoming space that feels more comfortable than clinical. Before your infusion begins, your care team will:
- Review your current health status and any symptoms you have noticed
- Check your blood pressure, which is measured at every visit because ZIRABEV™ can raise it
- Confirm your weight, since your dose is calculated from it
- Review your urine protein results, which are monitored throughout treatment
- Ask about any recent surgery, unhealed wound, or upcoming procedure, including dental work
- Prepare your dose in sodium chloride, never dextrose, and place your IV using a gentle, practiced technique
- Administer your ZIRABEV™ infusion with our nursing team at your side
- Monitor you closely for any infusion-related reactions
- Protect your privacy and comfort throughout the visit
Your first infusion usually takes about 90 minutes. If you tolerate it well, the next runs over 60 minutes and later ones over 30, with treatment repeating every two or three weeks alongside your chemotherapy schedule. If you are also receiving interferon alfa for kidney cancer, that is a self-administered injection you take at home three times a week rather than something given at the infusion center.
Many patients continue ZIRABEV™ on its own after chemotherapy ends, and those visits are shorter and simpler. Tell your care team about any planned procedure as far ahead as you can, since bevacizumab stays in the body for around 20 days and surgical timing is planned around it.
ZIRABEV™ Side Effects
As with any medication, ZIRABEV™ may cause side effects. Being informed helps you know what to watch for and when to contact your healthcare team. Because this medicine works on blood vessels rather than the immune system, the things to watch for are different from immunotherapy: blood pressure, bleeding, protein in the urine, and wound healing.
Common Side Effects:
- Nosebleeds
- High blood pressure
- Protein in the urine
- Headache
- Runny nose or other upper respiratory symptoms
- Taste changes
- Dry skin or peeling skin
- Rectal bleeding
- Watery eyes
- Back pain
- Fatigue
High blood pressure and protein in the urine often cause no symptoms at all, which is why your team checks for both at your visits rather than waiting for you to feel something.
Although rare, serious side effects can occur. Please alert our clinical staff or seek medical attention immediately if you experience any of the following:
- Gastrointestinal perforation or fistula, a tear or abnormal connection in the stomach or intestine (severe abdominal pain, fever, nausea, vomiting, or constipation)
- Impaired wound healing or wound reopening, which is why treatment is paused before and after surgery
- Necrotizing fasciitis, a rare but serious soft tissue infection, usually following a wound complication
- Serious bleeding, including coughing up blood, severe nosebleeds, vaginal or rectal bleeding, or bleeding in the brain
- Arterial thromboembolic events, such as stroke, heart attack, or mini-stroke
- Venous blood clots (leg swelling or pain, or sudden shortness of breath)
- Severe or uncontrolled high blood pressure (headache, vision changes, or chest pain)
- Posterior reversible encephalopathy syndrome (headache, seizures, confusion, or vision loss)
- Kidney injury, including nephrotic syndrome (foamy urine or swelling in the legs, hands, or face)
- Heart failure (shortness of breath, swelling, or rapid weight gain), particularly if you have had anthracycline chemotherapy or chest radiation
- Infusion-related reactions (chills, flushing, shortness of breath, or chest tightness)
- Ovarian failure, which matters especially for patients who may want to become pregnant. Talk with your oncologist about fertility preservation before treatment starts
One thing that sets ZIRABEV™ apart from most infusion medicines: there are no dose reductions. If a side effect becomes a problem, your oncologist will either hold treatment temporarily or stop it, rather than lowering the dose.
ZIRABEV™ can harm an unborn baby. Use effective contraception during treatment and for six months after your last dose, and do not breastfeed during treatment or for six months after your last dose.
Patient Forms
Before you attend your first appointment at Violet Health, please make sure to review the documents below. Please contact us if you have any questions!
Patient Consent Form
HIPAA Privacy Authorization Form
Notice of Privacy Practices
Patient Rights and Responsibilities
Appointment Lateness and Cancelation
Meet our Infusion Specialists
Jalal Thwainey M.D.
Medical Director
Emilie Wojcik, N.P.
Director of Clinical Services
For Provider
Simplify patient referrals and offer advanced treatment options with our infusion partnership program.
For Patient
There may be a better way to manage your condition – explore infusion therapy.