Bevacizumab

Bevacizumab is a prescription medication used to treat symptoms of Glioblastoma (GBM), a fast growing brain tumor. It is also used to treat colorectal cancer, lung cancer, renal cell cancer (a type of cancer that begins in the kidney), cervical cancer, ovarian, fallopian tube and peritoneal cancer (cancer of the tissues that lines the stomach). Bevacizumab belongs to a group of drugs called antiangiogenic agents, which stops blood vessels that feed tumors from forming.

This medication comes in a liquid form and is injected intravenously (into a vein) by your doctor or healthcare provider. You will most likely receive an injection every 2 or 3 weeks.

Common side effects of bevacizumab include nosebleeds, headache, and high blood pressure. 

Bevacizumab is approved by the U.S. Food and Drug Administration (FDA) to be used alone or with other medicines to treat:

• Glioblastoma (GBM), a fast-growing brain tumor, that has not gotten better with other types of treatment.

Bevacizumab is also approved to be used with other medicines to treat the following types of cancer:

• colorectal cancer that has spread to other parts of the body (metastatic colorectal cancer (mCRC))
• non-small cell lung cancer (NSCLC)
• kidney cancer that has spread to other parts of the body (metastatic kidney cancer (mRCC))
• advanced cervical cancer
• ovarian cancer that is resistant to platinum therapy
  • fallopian tube cancer
  • primary peritoneal cancer

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Bevacizumab may be found in some form under the following brand names:

• Avastin

Serious side effects have been reported with bevacizumab. See the “Bevacizumab Precautions” section.

The most common side effects of bevacizumab are:

• nosebleeds
• headache
• high blood pressure
• inflammation of the nose
• too much protein in the urine
• changes in taste sensation
• dry skin
• rectal bleeding
• tear production disorder
• back pain
• skin inflammation

This is not a complete list of bevacizumab side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

No bevacizumab drug interactions have been identified, however, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Bevacizumab can cause serious side effects. See "Bevacizumab FDA Warning."

The most serious side effects that can occur with bevacizumab treatment are:

• a hole develops in the stomach or intestine (gastrointestinal perforation). Call your doctor right away if you have stomach pain, constipation, nausea (upset stomach), vomiting, or fever. This is a serious, possibly life-threatening condition.

• a surgical wound (cut) that won't heal. Call your doctor right away if you experience this problem. Don't take bevacizumab for at least 28 days before or after surgery and until surgical wounds are fully healed.
• serious bleeding (coughing or vomiting blood). This condition can be life-threatening. Call your doctor right away if you have nosebleeds, if your gums bleed, or if you cough up blood or vomit blood.
• increased the risk of high blood pressure, congestive heart failure (CHF), strokes, heart attacks, chest pain, and transient ischemic attacks (TIAs, or "mini-strokes"). Tell your doctor if you have heart disease or if you have ever had any of these conditions.

These most serious side effects are rare, but can be fatal.

Other possible side effects include:

• an abnormal passage in the body from one part of the body to another (can be fatal)
• stroke or other heart problems
• severely high blood pressure
• vision problems
• kidney problems
• ovaries stop working
• infusion reactions involving breathing problems, chest pain, and excessive sweating

Do not receive bevacizumab if you are allergic to any ingredient in it. Tell your doctor if you are allergic to any medication.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of bevacizumab there are no specific foods that you must exclude from your diet when receiving bevacizumab.

Tell your doctor if you are allergic to any ingredient in bevacizumab.

Tell your doctor about all of your medical conditions, including if you:

• have high blood pressure (hypertension)
• have heart disease (history of heart attack, stroke, blood clot, congestive heart failure)
• have kidney disease
• have any infection or fever
• are planning to have surgery
• are pregnant or breastfeeding

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if bevacizumab is excreted in human breast milk or if it will harm your nursing baby.

Bevacizumab comes as a liquid to be injected intravenously (into a vein) by your doctor or healthcare provider in a medical setting (hospital or clinic). The first injection will last 90 minutes. You will likely receive an injection every 2 or 3 weeks, depending upon the condition being treated.

• The first injection will last 90 minutes.
• If the first injection is received with no serious side effects, the second injection will be given over 60 minutes. 
• If the infusion over 60 minutes was tolerated, the next doses will be given over 30 minutes.

Your doctor will determine how much bevacizumab you will receive and how often you will receive it based on your weight and the condition being treated.

For the treatment of glioblastoma, a brain cancer, bevacizumab is usually given every 2 weeks.

For the treatment of colorectal cancer, bevacizumab is usually given every 2 or 3 weeks in combination with other cancer medicines.

For the treatment of kidney cancers, bevacizumab is usually given every 2 weeks in combination with other medicines.

For the treatment of non-small cell lung and cervical cancer, bevacizumab is usually given every 3 weeks in combination with other cancer medicines.

For the treatment of ovarian, fallopian, peritoneal cancers, bevacizumab is usually given every 2 or 3 weeks and will depend on what other medications are given in combination with bevacizumab and if the cancer is resistant to platinum therapy. 

If bevacizumab is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Keep all medical and laboratory appointments. To get the most benefit, you should receive bevacizumab doses as scheduled. If you miss an appointment, reschedule as soon as possible. 

Gastrointestinal Perforations

Bevacizumab administration can result in the development of gastrointestinal perforation, in some instances resulting in fatality.

• Gastrointestinal perforation, sometimes associated with intra-abdominal abscess, occurred throughout treatment with bevacizumab (i.e., was not correlated to duration of exposure).
• The incidence of gastrointestinal perforation (gastrointestinal perforation, fistula formation, and/or intra-abdominal abscess) in patients with colorectal cancer and in patients with non-small cell lung cancer (NSCLC) receiving bevacizumab was 2.4% and 0.9%, respectively. The typical presentation was reported as abdominal pain associated with symptoms such as constipation and vomiting.
• Gastrointestinal perforation should be included in the differential diagnosis of patients presenting with abdominal pain on bevacizumab.
• Bevacizumab therapy should be permanently discontinued in patients with gastrointestinal perforation.

Wound Healing Complications

• Bevacizumab administration can result in the development of wound dehiscence, in some instances resulting in fatality.
• Bevacizumab therapy should be permanently discontinued in patients with wound dehiscence requiring medical intervention.
• The appropriate interval between termination of bevacizumab and subsequent elective surgery required to avoid the risks of impaired wound healing/wound dehiscence has not been determined.

Hemorrhage

• Fatal pulmonary hemorrhage can occur in patients with non-small cell lung cancer treated with chemotherapy and bevacizumab.
• Incidence: The incidence of serious or fatal hemoptysis was 31% in patients with squamous histology and 2.3% in patients with NSCLS excluding predominant squamous histology.
• Patients with recent hemoptysis (at least one-half teaspoonful of red blood) should not receive bevacizumab.