bevacizumab

Pronunciation

Generic Name: bevacizumab (bev a CIZ oo mab)
Brand Name: Avastin

What is bevacizumab?

Bevacizumab is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Bevacizumab is used to treat a certain type of brain tumor, and certain types of cancers of the kidney, lung, colon and rectum. It is usually given as part of a combination of cancer medicines.

Bevacizumab may also be used for purposes not listed in this medication guide.

What is the most important information I should know about bevacizumab?

Bevacizumab can make it easier for you to bleed. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines, or in your brain.

Call your doctor at once if you have: signs of bleeding in your digestive tract-- feeling very weak or dizzy, severe stomach pain, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds; or signs of bleeding in the brain--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, or problems with vision or balance.

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Bevacizumab should not be used within 28 days before or after a planned surgery.

Bevacizumab can also cause problems with wound healing, which could result in bleeding or infection. Call your doctor if you have signs of any skin infection (sudden redness, warmth, swelling, or oozing), or any skin wound or surgical incision that will not heal.

What should I discuss with my healthcare provider before receiving bevacizumab?

You should not use bevacizumab if you are allergic to it, or:

  • if you have slow healing of a skin wound or surgical incision;

  • if you have had surgery within the past 4 weeks (28 days);

  • if you have recently been coughing up blood; or

  • if you plan to have surgery within the next 4 weeks (28 days).

To make sure bevacizumab is safe for you, tell your doctor if you have:

  • heart disease, high blood pressure;

  • a history of heart attack, stroke, or blood clots;

  • a bleeding or blood-clotting disorder; or

  • a history of stomach or intestinal bleeding, or perforation (a hole or tear) in your esophagus, stomach, or intestines.

FDA pregnancy category C. It is not known whether bevacizumab will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Bevacizumab may cause a woman's ovaries to stop working correctly. Symptoms of ovarian failure include 3 or more missed menstrual periods in a row. This may affect your fertility (ability to have children). Talk to your doctor about your specific risks.

It is not known whether bevacizumab passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are being treated with bevacizumab.

Older adults may be more likely to have side effects from this medication.

How is bevacizumab given?

Bevacizumab is injected into a vein through an IV. A healthcare provider will give you this injection.

Bevacizumab is usually given once every 2 weeks.

Bevacizumab can cause problems with wound healing, which could result in bleeding or infection. If you need to have any type of surgery, you will need to stop receiving bevacizumab at least 4 weeks ahead of time. Do not start using bevacizumab for at least 4 weeks after surgery, or until your surgical incision heals.

To be sure this medication is not causing harmful effects, your blood pressure will need to be checked often. Protein levels in your urine may also need to be tested.

Bevacizumab must be stored in a refrigerator and kept from freezing. Bevacizumab bottles should never be shaken.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your bevacizumab injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using bevacizumab?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Bevacizumab side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Bevacizumab can cause a rare but serious neurologic disorder affecting the brain. Call your doctor at once if you have a headache, confusion, vision problems, feeling very weak or tired, fainting, or seizure (blackout or convulsions). These rare symptoms may occur within hours of your first dose of bevacizumab, or they may not appear for up to a year after your treatment started.

Some people receiving bevacizumab have developed a fistula (an abnormal passageway) within throat, lungs, gallbladder, kidney, bladder, or vagina. Call your doctor if you have: chest pain and trouble breathing, stomach pain or swelling, urine leakage, or if you feel like you are choking and gagging when you eat or drink.

Bevacizumab can make it easier for you to bleed. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop. You may also have bleeding on the inside of your body, such as in your stomach or intestines, or in your brain.

Call your doctor at once if you have:

  • signs of bleeding in your digestive tract--severe stomach pain, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds;

  • signs of bleeding in the brain--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, or problems with vision or balance;

  • signs of any skin infection--sudden redness, warmth, swelling, or oozing, or any skin wound or surgical incision that will not heal;

  • easy bruising, unusual bleeding (nose, mouth, vagina, rectum), purple or red pinpoint spots under your skin, or any bleeding that will not stop;

  • fever, vomiting, and constipation;

  • swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough;

  • pain, swelling, warmth, or redness in one or both legs;

  • chest tightness or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;

  • missed menstrual periods; or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, shortness of breath, uneven heartbeats).

Some people receiving a bevacizumab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel dizzy, nauseated, light-headed, sweaty, or have a headache, wheezing, or chest pain during the injection.

Common side effects may include:

  • mild or occasional headache;

  • runny nose, sneezing;

  • dry or watery eyes;

  • dry or flaky skin, hair loss;

  • changes in your sense of taste; or

  • back pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Bevacizumab dosing information

Usual Adult Dose for Colorectal Cancer:

5 mg/kg IV every 2 weeks when used in combination with irinotecan, fluorouracil, and leucovorin in the IFL regimen.

10 mg/kg IV every 2 weeks when used in combination with oxaliplatin, folinic acid, and fluorouracil in the FOLFOX4 regimen.

Administer 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks when used in combination with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line bevacizumab containing regimen.

Duration of therapy: Continue treatment until disease progression or unacceptable toxicity occurs.

Comments: The first dose of bevacizumab should be delivered over 90 minutes as an IV infusion following chemotherapy. If the first infusion is well tolerated, the second infusion may be administered over 60 minutes. If the 60 minute infusion is well tolerated, all subsequent infusions may be administered over 30 minutes, if tolerated.

Usual Adult Dose for Non-Small Cell Lung Cancer:

For use in combination with carboplatin and paclitaxel for the treatment of non-squamous, non-small cell lung cancer:

Initial dose: 15 mg/kg as an IV infusion every 3 weeks

The first dose of bevacizumab should be delivered over 90 minutes as an IV infusion following chemotherapy. If the first infusion is well tolerated, the second infusion may be administered over 60 minutes. If the 60 minute infusion is well tolerated, all subsequent infusions may be administered over 30 minutes.

Usual Adult Dose for Breast Cancer:

(Not approved by FDA)

Recommended dose: 10 mg/kg as an IV infusion every 14 days in combination with paclitaxel.

Usual Adult Dose for Glioblastoma Multiforme:

Recommended dose: 10 mg/kg every 2 weeks

Usual Adult Dose for Ovarian Cancer:

15 mg/kg IV every 3 weeks

Usual Adult Dose for Renal Cell Carcinoma:

10 mg/kg IV every 2 weeks in combination with interferon alfa

Usual Pediatric Dose for Solid Tumors:

Monotherapy: 15 mg/kg IV every 2 weeks in 28 day cycles

Combination therapy: 5 to 10 mg/kg IV every 2 weeks as a part of combination chemotherapy regimens

What other drugs will affect bevacizumab?

Other drugs may interact with bevacizumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about bevacizumab.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 13.02. Revision Date: 2013-08-28, 9:43:15 AM.

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