Zenocutuzumab-zbco (Bizengri®)

This therapy works by targeting certain protein receptors found on certain types of cancer cells. Zenocutuzumab-zbco is a bispecific HER2- and HER3-directed antibody. This medication binds to protein receptors called HER2 and HER3 that are found on the surface of some cancer cells. By blocking or stopping HER2 and HER3 from working, this medication can stop or slow down cancer growth. Before receiving this medication, your tumor will be tested for a Neuregulin 1 (NRG 1) gene fusion that must be present for this medication to work.

How to Take Zenocutuzumab-zbco (Bizengri®)

Zenocutuzumab-zbco is given by intravenous (IV, into a vein) infusion over 4 hours every 2 weeks. You will be given “pre-medications” before each dose of zenocutuzumab-zbco. These may include a steroid, a histamine-1 (H1) receptor antagonist (such as diphenhydramine/Benadryl), an antipyretic (such as acetaminophen/Tylenol), and medications to prevent nausea. You may also need to stay for monitoring for at least 1 hour after your infusion.

You will need an echocardiogram (“echo”), MRI, or other type of scan to test how the left ventricle of your heart is working before receiving this medication. Tell your care team if you have a history of congestive heart failure (CHF). Your heart will be tested throughout treatment with zenocutuzumab-zbco.

Possible Side Effects of Zenocutuzumab-zbco (Bizengri®)

There are a number of things you can do to manage the side effects of zenocutuzumab-zbco  Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Liver Toxicity

This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Electrolyte Abnormalities

This medication can affect the normal levels of electrolytes (magnesium, phosphate, potassium, sodium, etc.) in your body. Your levels will be monitored using blood tests. If your levels become too low, your care team may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your care team.

Muscle or Joint Pain/Aches

Your healthcare provider can recommend medications and other strategies to help relieve pain.

Important but Less Common Side Effects

• Heart problems: this medication can cause heart problems, or worsen pre-existing heart problems, including congestive heart failure. Your heart function will be tested using an echocardiogram or MUGA scan prior to starting treatment with this medication and every couple of months while on treatment and after completion of treatment. Notify your healthcare provider if you have a sudden weight gain or swelling in the ankles or legs. If heart function decreases, this medication will be stopped.
• Pulmonary toxicity: This medication can affect the lungs, especially during the first week of treatment. Patients can develop interstitial lung disease which is scarring of the lung tissue or pneumonitis which is an inflammation of the lungs. Notify your healthcare provider right away if you develop any new or worsening symptoms, including trouble breathing or shortness of breath, chest pain, cough, or fever.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant while on this medication. Effective birth control is necessary during treatment and for at least 2 months after treatment, even if your menstrual cycle. You should not breastfeed while taking this medication or for 2 months after your last dose.