OncoLink en espanõl
Treatment Options > Chemotherapy > OncoLink Rx
Bevacizumab (AvastinTM)
Ryan P. Smith, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: August 8, 2005
Other Name: Avastin (ah-VAS-tin)
| What it is used for: | Avastin has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of metastatic colon or rectal carcinoma, in combination with other chemotherapy drugs. |
| How it works: | Bevacizumab is a monoclonal antibody that binds to and inhibits the activity of vascular endothelial growth factor (VEGF). Hence, it inhibits the interaction of VEGF with its receptor on endothelial cells (lining of blood vessel). This, in turn, inhibits the proliferation of endothelial cells and thus inhibits new blood vessel formation. In essence then, it kills tumors by cutting off its own blood supply. |
| How it is given: | Bevacizumab is administered intravenously, dosed individually, according to the patient.s body mass. The dose used is 5 mg/kg every 2 weeks. The total dose is delivered over 90 minutes as an initial infusion. If the first dose is well tolerated, the second infusion could be administered over 60 minutes. If this is well tolerated as well, subsequent infusions can be given over 30 minutes. No premedication is needed prior to the administration of Avastin. |
It should be noted that the approval for bevacizumab is derived from two large, randomized clinical trials where bevacizumab was combined with either IFL chemotherapy (irinotecan, 5-fluorouracil (5-FU), leucovorin) or 5-fluorouracil and leucovorin chemotherapy. It is not approved as a single agent. Therefore, this should be kept in mind as the use and side effects are reviewed.
Side effects and Precautions
Let your doctor or nurse know if you have any allergies and what medications you are currently taking, both prescription and over the counter medications. This includes vitamins, herbs, nutritional supplements and any recreational drugs. Not everyone experiences side effects and most side effects are temporary. Again, keep in mind that bevacizumab will usually be given with 5-FU based chemotherapy. Therefore, the toxicity of bevacizumab should be thought of with 5-FU (and likely irinotecan) in mind. The side effects that you may experience are:
Hemorrhage
Most commonly, this includes nosebleeds, which are minor and not thought to be serious. More serious bleeding events have occurred in patients that were treated for lung cancer (for which Avastin is not approved). Other serious bleeding events are uncommon, though if they occur, bevacizumab should be discontinued
What to do: Minor nosebleeds should not be of much concern, though alert your physician if these occur. Obviously, any major bleeding event should be treated as an emergency.
Hypertension
The incidence of blood pressure readings that were >150/100 mmHg were increased in those patients receiving bevacizumab in the previously mentioned clinical trials. Severe hypertension (>200/110 mmHg) was also noted in 7-10% of patients. This seemed to be more severe in patients with high blood pressures before taking Avastin.
What to do: Your blood pressure should be monitored at every clinic visit. If severe hypertension develops, bevacizumab should be discontinued immediately. Signs of severe hypertension when away from the clinic include blurry vision, severe headache, fatigue, or problems with urination. If any of these occur, alert your physician.
Gastrointestinal Perforation/Wound Healing Complications
Gastrointestinal perforation (the development of an abnormal break in the wall of the stomach, intestines, or colon) occurred in an increased incidence in patients treated with bevacizumab. These episodes often resulted in an abscess formation. This may be due to the impaired wound healing induced by bevacizumab. Therefore, it is recommended that bevacizumab not be given within at least 28 days following major surgery. In addition, the surgical incision should be fully healed prior to initiation of bevacizumab. Though this is a severe complication, the risk is small.
What to do: The typical presentation of wound breakdown and gastrointestinal perforation is abdominal pain (often severe) with associated constipation and/or vomiting. Therefore, any severe abdominal pain should be regarded as an emergency. Obviously, discontinuation of bevacizumab is warranted in these instances.
Congestive Heart Failure
Patients receiving Avastin experienced congestive heart failure, defined as dysfunction in the heart chamber, at a slightly higher rate. It was often in patients who had received anthracycline chemotherapy (adriamycin) prior to bevacizumab.
What to do: If symptoms of congestive heart failure develops (shortness of breath, worsened by lying flat, leg swelling, chest pain, severe fatigue), alert your physician immediately. Avastin should be discontinued in these cases.
Again, it is noted that bevacizumab will most often be administered concurrently with irinotecan and/or 5-FU. In these patients receiving combination chemotherapy, a broad range of minor side effects were noted, including body aches, diarrhea, nausea/vomiting, decrease in appetite, headache, and constipation.