Avastin Disease Interactions

Bevacizumab may cause fatal fistula formation involving tracheoesophageal, bronchopleural, biliary, vaginal, renal and bladder sites. Permanently discontinue bevacizumab in patients with tracheoesophageal fistula or any Grade 4 fistula. Discontinue bevacizumab in patients with fistula formation involving an internal organ.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

Bevacizumab impairs wound healing and increases the occurrence of wound-related complications, which might require surgical intervention. Bevacizumab should not be started for at least 28 days after surgery and until the wound is fully healed. Discontinue bevacizumab in patients with wound healing complications requiring medical intervention or in patients who develop necrotizing fasciitis. Do not administer this agent to patients with recent history of hemoptysis and discontinue bevacizumab in patients with hemorrhage. Caution is recommended when using this agent in patients at increased risk of bleeding or before surgery and is recommended to stop therapy for at least 28 days prior to elective surgery.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) have been associated with severe increases in blood pressure. Therapy with these agents should be administered cautiously in patients with preexisting hypertension. Blood pressure should be assessed prior to initiating treatment, regularly during treatment and after discontinuation in patients with bevacizumab -induced or -exacerbated hypertension. Temporarily suspend these agents in patients with severe hypertension that is not controlled with medical management. Discontinue these agents in patients with hypertensive crisis or hypertensive encephalopathy.

Posterior Reversible Encephalopathy Syndrome (PRES) has been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR) in clinical studies. PRES is a neurological disorder which can present with headache, seizure, lethargy, confusion, blindness and other visual and neurologic disturbances. It is recommended to discontinue these agents in patients developing PRES. The safety of restarting therapy is not known. Cation is recommended if therapy is reinitiating in patients previously experiencing PRES.

The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.