Bevacizumab (Avastin®)
Pronounce: BEV-a-SIZ-oo-mab
Classification: Monoclonal Antibody
About Bevacizumab (Avastin®)
An antibody is a protein made by your body to help your immune system find and stop bacteria and viruses from attacking your body. A monoclonal antibody is an antibody made in a lab that can attach to certain cancer cells in your body. Your immune system then attacks and kills the cancer cell that it is attached to. Monoclonal antibodies work with your immune system to kill cancer cells by:
- Helping your immune system attack the cancer cells.
- Blocking growth of the cancer cells.
- Blocking other things the cancer cells need.
Ask your provider about the type of monoclonal antibody you are taking and how it works.
Bevacizumab is a monoclonal antibody that binds to and inhibits the activity of vascular endothelial growth factor (VEGF). This prevents the VEGF from interacting with its receptor on endothelial cells (lining of blood vessel). This, in turn, inhibits the formation of new blood vessels, which slows down the growth of the particular tissue. In essence, it kills tumors by cutting off their blood supply.
There are biosimilar versions of bevacizumab. A biosimilar is a medication that has been approved by the FDA because it is very similar to an FDA-approved medication (called a reference product, or the medication it is being compared to), and that there are no meaningful differences between the biosimilar product and the reference product. These medications may be used interchangeably.
The biosimilar versions of this medication include bevacizumab-awwb (Mvasi), bevacizumab-bvzr (Zirabev®), bevacizumab-tnjn (Avzivi), bevacizumab-adcd (Vegzelma), bevacizumab-maly (Alymsys), and bevacizumab-nwgd (Jobevne).
How to Take This Medication
This medication is given by intravenous (IV, into a vein) infusion. The amount of time the infusion will take will depend on your treatment plan and if you tolerate the medication. Dosage depends on the person’s size and type of cancer being treated. How often you receive this medication and what other medications you receive will be determined by your provider.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
High Blood Pressure
This medication can cause high blood pressure (hypertension). Your blood pressure should be monitored at every clinic visit or every 2-3 weeks. If your blood pressure is elevated, you may be treated with a medication to reduce your pressure. If severe hypertension develops, this medication should be discontinued immediately. Your blood pressure should continue to be monitored, even if the medication is stopped. Signs of hypertension to report to your provider include: blurry vision, nosebleed, headache, and fatigue.
Fatigue
Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.
Bleeding
Patients may experience minor bleeding, such as a nosebleed. Serious bleeding has also occurred in patients treated with this medication, including coughing up blood, bleeding into the stomach, vomiting blood, bleeding in the brain (stroke), and vaginal bleeding. People who have had serious bleeding should not take this medication. These events are uncommon, though if they occur, this medication should be discontinued. While a nosebleed may not seem like much of a concern, you should notify your provider right away if you develop bleeding of any sort.
Fertility
This medication may affect your fertility. It can cause changes to your menstrual cycle. You may want to consider egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment. This medication can change how your ovaries work. You might have symptoms like hot flashes and vaginal dryness.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 6 months after the last dose of this medication, even if your menstrual cycle has stopped or changed. If you can get someone pregnant, you will need to use effective birth control during treatment and for 6 months after the last dose of this medication, even if you believe you are not producing sperm. You should not breastfeed during treatment and for 6 months after the last dose of this medication.
Important but Less Common Side Effects
Wound Healing
This medication can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that the medication be discontinued 4 weeks prior to any surgery. In addition, the medication should be held for 28 days after surgery and any surgical incision should be fully healed prior to starting or restarting the medication. If you have a surgical wound that has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your provider.
Kidney Damage
Kidney damage can occur while receiving this medication. Your provider will monitor this by periodically checking the amount of protein in your urine. If the protein levels become elevated, you may require further urine tests to evaluate your kidney function. If your kidneys become damaged, you may need to stop receiving this medication
Blood Clots, Heart Attack, and Stroke
This medication increases your risk for blood clots, stroke, and heart attack. Symptoms may be:
- Swelling, redness, or pain in an arm or leg.
- Chest pain or pressure.
- Pain in your back, neck, or jaw.
- Shortness of breath.
- Numbness or tingling.
- Confusion.
- Having trouble talking.
Tell your provider right away if you have any of these symptoms.
Infusion-Related Side Effects
Some people may have a reaction during infusion of this medication. These can be:
- Chills.
- Fever.
- Low blood pressure.
- Nausea.
- Vomiting.
Your provider will monitor you for symptoms of infusion-related reactions.
Gastrointestinal (GI) Tear
This medication can cause gastrointestinal (GI) perforation, or a tear, in the wall of your intestines. Signs of this can be:
- New or worsening pain in the abdomen (belly).
- New abdominal swelling.
- Chills.
- Fever.
- Constipation.
- Nausea or vomiting.
If you have any of these symptoms, call your provider.
Posterior Reversible Encephalopathy Syndrome (PRES)
This medication can cause a neurological (brain) disorder called posterior reversible encephalopathy syndrome (PRES or reversible posterior leukoencephalopathy (RPLS). Symptoms of PRES/RPLS are:
- Headache.
- Seizure.
- Lethargy (feeling tired, drowsy, sluggish).
- Confusion.
- Blindness and other vision changes.
- Neurological problems.
Tell your provider about any of these symptoms right away.
Fistula
A possible, but rare, side effect is the development of a fistula, which is an abnormal passage between two body parts (for instance, a hole between the lung and esophagus).
Congestive Heart Failure (CHF)
This medication can cause or worsen pre-existing heart problems, including congestive heart failure. Notify your provider if you have sudden weight gain or swelling in the ankles or legs. If you develop chest pain or pressure, sweating, shortness of breath, nausea, dizziness or lightheadedness, call 911 or go to the nearest emergency room.