Cizumab  

Category: Monoclonal antibody or Anti-angiogenesis drug Bevacizumab is sold under the brand name Cizumab which belongs to vascular endothelial growth factor directed antibody, the main ingredient which is used as bevacizumab. Cizumab consist of human framework regions and murine complementarity-determining regions. Cizumab is a combined human monoclonal antibody IgG1, that predicament to and prohibits the biological activity of human vascular endothelial growth factor (VEGF)

INDICATION

Cizumab is indicated for the treatment :
• In combination with 5-fluorouracil chemotherapy administered intravenously, first or second line drug of choice for Metastatic colon or rectal cancer
• Concurrent use with carboplatin and paclitaxel as first line therapy for Non-squamous, non-small cell lung cancer
• Used in the treatment of recurrent Glioblastoma in adults
• Concurrent use with interferon alfa for Metastatic renal cell cancer
• Concurrent use with paclitaxel & cisplatin or paclitaxel & topotecan for Metastatic cervical cancer
• In combination with paclitaxel, pegylated liposomal doxorubicin or topotecan for Epithelial ovarian, fallopian tube or peritoneal cancer.

Key point :

Avoid administrating Cizumab before at least 28 days following surgery and the wound is completely cured

Metastatic colorectal carcinoma :

The Cizumab usual dosage by concomitant with 5-fluorouracil based chemotherapy. Cizumab 5mg/kg for every 2 weeks IV in concomitant with bolus IFL Cizumab 10mg/kg for every 2 weeks IV in combination with FOLFOX4 Cizumab 5mg/kg IV for every 2 weeks or Cizumab 7.5 mg/kg as IV every 3 weeks by concurrently take with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer :

The patients regular dosage of Cizumab is 15mg/kg IV for every 3 weeks by interacting with carboplatin and paclitaxel

Glioblastoma :

Cizumab 10mg/kg administered IV for every 2 weeks

Metastatic renal cell cancer :

Concurrent use with interferon alfa.: The usual dose of Cizumab is 10mg/kg IV for every 2 weeks

Metastatic cervical cancer :

The usual dose of Cizumab; Cizumab 15mg/kg given intravenously for every 3 weeks by combining with paclitaxel and cisplatin or with paclitaxel and topotecan

Epithelial ovarian, fallopian tube or peritoneal cancer :

The usual dose of Cizumab for Platinum opposing:; 10mg/kg of Cizumab for every 2 weeks by concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan Or The regular dosage of Cizumab; 15mg/kg of Cizumab given through IV for every 3 weeks by combining with topotecan The usual dose of Cizumab for Platinum responsive; 15mg/kg given IV for 3 weeks in concomitant with carboplatin and paclitaxel for 6 to 8 cycles The recommended dosage of Cizumab; 15mg/kg of Cizumab given IV for 3 weeks by combining with gemcitabine & carboplatin for 6 to 10 cycles.

PHARMACOKINETICS

The pharmacokinetic form of Cizumab is assayed by measuring total serum Bevacizumab concentration.

Distribution :

The volume of distribution is 2.9 (22%) L

Elimination :

The terminal half life period of Bevacizumab is 20days (11 to 50days)

MECHANISM OF ACTION

Cizumab constitute an active ingredient like Bevacizumab which joined to VEGF and will not have communication of VEGF to its receptors like Flt-1 & KDR that present on the surface of the cells. While this interaction inhibits endothelial cell proliferation and new blood vessel production occurs Hence in counts discontinuation of metastatic tumor cells growth happens

PREPARATION & ADMINISTRATION

Cizumab is intravenous solution At initial infusion: given IV infusion over 90 minutes Following infusions: give second infusion over 60 minutes, if tolerated Administer all following infusion over 30minutes Cizumab IV infusion is prepared in aseptic condition Cizumab 400mg containing 16ml solution whereas 100mg containing 4ml Cizumab dilute into 100ml of 0.9% NS Do not dilute with dextrose solution Dispose the remaining drug which is left in a vial under guidance of pharmacist.

PRECAUTION

Caution with use in the conditions like ;
Previously If you have taking or ever had DPD (dihydropyrimidine dehydrogenase) deficiency of enzyme . Inform the doctor about this then your doctor may preferably inform you avoid taking Cizumab. Discuss with the doctor that you have or have ever had renal, hepatic, or cardiac problem Discuss with the doctor that are you pregnant or plan to become pregnant. Avoid planning to have children while on treatment with Cizumab. You should use a essential method of conceiving to prevent pregnancy in yourself or your partner during your treatment with Cizumab. The drug will harm the fetus. Avoid breast feeding while on treatment with Cizumab While using Cizumab these are some other complications occurred during therapy, care should be taken Hypertension Posterior reversible encephalopathy syndrome Gastrointestinal perforations Wound healing complications Hemorrhage Arterial thromboembolic events Venous thromboembolic events Embryo fetal toxicity occurs

MISSED DOSE

If patient fail to take the dose or missed the cycle means must consult with oncologist and follow the regular dosing schedule Do not take overdose

STORAGE

Cizumab vial should be stored at 2 to 8(36 to 46℃) Single use vial Discard the left out medicine under guidance of pharmacist

CONTRAINDICATION

No contraindication occurred

DRUG INTERACTION

While interaction of Cizumab with paclitaxel & Carboplatin, leads to lowering in exposure of paclitaxel after four cycles of therapy.

SIDE EFFECTS

Gastrointestinal perforation and fistulae
Surgery and wound healing complication
Hemorrhage
Arterial thromboembolic events
Venous thromboembolic events
Hypertension
Posterior reversible encephalopathy syndrome
Renal injury & Proteinuria
Infusion reactions
Ovarian failure
Congestive heart failure
Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysaesthesia.