Inclusion Criteria:

- Histologically confirmed well differentiated or moderately differentiated
neuroendocrine tumor from either a primary or metastatic site

- Must have disease that is not amenable to curative resection

- Must have evidence of disease progression within 12 months prior to study entry

- Must have measurable disease (RECIST 1.1)

- Prior chemoembolization of local ablative therapies are allowed, provided there is
measurable disease outside of the area treated, or documented evidence of progression
at the site of prior treatment

- No limit to number of prior treatments. Prior bevacizumab allowed unless discontinued
due to unacceptable toxicity. Prior TKI targeting VEGF receptors allowed

- Treatment with a somatostatin analog required for all subjects

- Subjects with history of hypertension must be adequately controlled

- Therapeutic anticoagulation is allowed. Must be on a stable dose of anticoagulant
medication

- Must agree to use adequate contraception prior to study entry, for the duration of
study participation and for 3 months after last administration of study drug

Exclusion Criteria:

- Prior treatment including chemoembolization within 4 weeks of study entry

- Major surgery within 4 weeks of study entry or minor surgery within 2 weeks of study
entry

- Pregnant or breastfeeding

- Poorly differentiated carcinoma, high grade neuroendocrine tumor or small cell
carcinoma

- Prior treatment with Ziv-aflibercept

- Pancreatic neuroendocrine tumor (islet cell carcinoma)will be excluded from this
study. All non functional and functional islet cell carcinomas such as insulinoma,
glucagonoma, gastrinoma, VIPoma will be excluded.

- Not adequately recovered from toxicity of previous therapy

- Known untreated brain or other central nervous system metastases

- Known allergy to any of the study agents or to compounds of similar chemical or
biologic composition

- History of congestive heart failure

- Symptomatic peripheral arterial disease

- Unhealed wounds, ulcers or bone fractures

- HIV positive or active Hepatitis infection

- History of abdominal fistula, GI perforation, intra abdominal abscess, uncontrolled
GI bleeding, diverticulitis within 6 months of study entry

- History of arterial thrombotic events such as myocardial infarction, unstable angina
pectoris or any ischemic or hemorrhagic cerebrovascular accident within the past 6
months

- No history of pulmonary embolism, DVT or vascular access related thrombosis if not
also receiving adequate anticoagulation at a stable dose.

- No history of prior or synchronous malignancy except if treated with curative intent
at least 3 years prior to study entry, or adequately treated non-melanoma skin
cancer, cervical carcinoma in situ, or prostate intraepithelial neoplasia without
evidence of prostate cancer

- Uncontrolled non-malignant illness that may increase the risks associated with study
participation or may interfere with the conduct of the study or interpretation of
study results

- Uncontrolled psychiatric illness or social situations that would limit compliance
with study requirements