Zaltrap

Zaltrap is the brand name for aflibercept, a recombinant fusion protein developed by Regeneron Pharmaceuticals and Sanofi. It functions as a decoy receptor for vascular endothelial growth factor (VEGF), binding VEGF-A, VEGF-B, and placental growth factor (PlGF) with high affinity. By sequestering VEGF, Zaltrap prevents VEGF from activating VEGF receptors on endothelial cells, thereby inhibiting angiogenesis and slowing tumor growth.

In the United States, Zaltrap was approved by the FDA in 2012 for use in combination with FOLFIRI (irinotecan, leucovorin, and fluorouracil) to treat adults with metastatic colorectal cancer whose disease progressed after oxaliplatin-containing therapy. The recommended dose is 4 mg/kg given as an intravenous infusion every two weeks, alongside FOLFIRI, with adjustments based on safety and tolerability. There are no approved indications for Zaltrap outside this metastatic colorectal cancer setting.

Clinical evidence supporting its use comes from the phase III VELOUR trial, which compared aflibercept plus FOLFIRI to FOLFIRI alone in patients previously treated with oxaliplatin. The trial demonstrated statistically significant improvements in overall survival and progression-free survival with the combination, leading to regulatory approval.

Common adverse events include hypertension, neutropenia, diarrhea, infection, proteinuria, fatigue, and mucocutaneous toxicities. Serious risks encompass arterial and venous thromboembolism, wound-healing impairment, bleeding, and infusion-related reactions. Patients require monitoring of blood pressure, kidney function, and wound healing, with dose modifications or discontinuation for intolerable toxicity. Zaltrap is indicated for metastatic colorectal cancer in the specified setting and does not have approved uses in other cancers.