Bevacizumab use while Breastfeeding

Drugs containing Bevacizumab: Avastin

Bevacizumab Levels and Effects while Breastfeeding

Summary of Use during Lactation

No information is available on the systemic use of bevacizumab during breastfeeding. Because bevacizumab is a large protein molecule with a molecular weight of about 149,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.[1] Until more data become available, bevacizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.

Two infants were breastfed, apparently without noticeable harm, following maternal intravitreal bevacizumab injections. Bevacizumab was undetectable in the milk of one mother, but vascular endothelial growth factor (VEGF) levels in breastmilk were suppressed following the injection. Because the breast and neonatal intestine have VEGF receptors, some authors recommend use of intravitreal ranibizumab, which does not appear to depress milk VEGF levels.[2]

Drug Levels

Maternal Levels. A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Her breastfed infant was 12 weeks old at the start of therapy. The bevacizumab dose and interval were not stated in the published report, but the usual intravitreal dose is 1.25 mg. After the first injection, bevacizumab was detectable in the maternal serum with a peak between 0.6 and 0.7 mcg/L at one week, but bevacizumab was not detectable in breastmilk at any time over the 42 days following injection. Vascular endothelial growth factor (VEGF) was also measured in serum and breastmilk. After the intravitreal injection of bevacizumab, the VEGF level in breastmilk decreased from 13.3 to 8.6 mcg/L over a 2-week period. After changing therapy to ranibizumab, no decrement in breastmilk VEGF was seen.[2]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A 33-year-old woman was treated with 14 intravitreal bevacizumab injections of 1.25 mg over a 20-month period. Five of these injections were given while she was breastfeeding (age of infant not stated). No mention was made of adverse effects in this infant, but she became pregnant again, received 3 additional injections, and delivered an infant who developed normally at 12 months of age.[3]

A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Her breastfed infant was 12 weeks old at the start of therapy. No mention was made of adverse effects in this infant.[2]

Possible Effects on Lactation

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

(Intravitreal) Ranibizumab

References

1. Pistilli B, Bellettini G, Giovannetti E et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39:207-11. PMID: 23199900

2. Ehlken C, Martin G, Stahl A, Agostini HT. Reduction of vascular endothelial growth factor a in human breast milk after intravitreal injection of bevacizumab but not ranibizumab. Arch Ophthalmol. 2012;130:1226-7. PMID: 22965611

3. Tarantola RM, Folk JC, Boldt HC, Mahajan VB. Intravitreal bevacizumab during pregnancy. Retina. 2010;30:1405-11. PMID: 20924262

Bevacizumab Identification

Substance Name

Bevacizumab

CAS Registry Number

216974-75-3

Drug Class

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antineoplastic Agents

Administrative Information

LactMed Record Number

825

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2013-09-07

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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