Avastin Side Effects

Generic name: bevacizumab

Medically reviewed by Philip Thornton, DipPharm. Last updated on Aug 2, 2024.

Note: This document provides detailed information about Avastin Side Effects associated with bevacizumab. Some dosage forms listed on this page may not apply specifically to the brand name Avastin.

Applies to bevacizumab: intravenous solution.

Serious side effects of Avastin

Along with its needed effects, bevacizumab (the active ingredient contained in Avastin) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking bevacizumab:

Other side effects of Avastin

Some side effects of bevacizumab may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to bevacizumab: intravenous solution.

Gastrointestinal

• Very common (10% or more): Abdominal pain (up to 61%), vomiting (up to 52%), anorexia (up to 43%), constipation (up to 40%), diarrhea (up to 34%), stomatitis (up to 32%), dyspepsia (up to 24%), gastrointestinal hemorrhage (up to 24%), flatulence (up to 19%)
• Common (1% to 10%): Dry mouth, colitis, constipation, nausea
• Very rare (less than 0.01%): TE fistula, upper aerodigestive tract hemorrhage
• Frequency not reported: Intestinal obstruction, intestinal necrosis, mesenteric venous occlusion, ileus, anastomotic ulceration, gastrointestinal perforation and wound dehiscence (complicated by intra-abdominal abscesses), tracheoesophageal fistulae^[Ref]

All three TE fistulas occurred during the bevacizumab maintenance phase of the study in the context of persistent esophagitis. Additionally, six other cases of TE fistula have been reported in other lung and esophageal cancer studies using bevacizumab and chemotherapy alone or with concurrent radiation treatment.

The incidence of gastrointestinal perforation (gastrointestinal perforation, fistula formation, and/or intraabdominal abscess) in patients with colorectal cancer and in patients with non-small cell lung cancer (NSCLC) receiving bevacizumab was 2.4% and 0.9%, respectively.^[Ref]

Cardiovascular

• Very common (10% or more): Hypertension (up to 34%), hypotension (up to 15%)
• Common (1% to 10%): Deep vein thrombosis, congestive heart failure
• Frequency not reported: Arterial thromboembolic events (including cerebrovascular accident (stroke), myocardial infarction, transient ischemic attack, angina), fatal arterial thrombotic events, cerebral ischemia, supraventricular tachycardia, both serious and non-serious hemorrhagic events^[Ref]

Risk factors for the development of arterial thromboembolic events have included a history of arterial thromboembolism prior to bevacizumab exposure, age 65 years and above, and bevacizumab therapy. These events have occurred at a higher rate in these high-risk groups.

In one study, the rate of congestive heart failure (defined as NCI-CTC grade 3 and 4) in the bevacizumab plus paclitaxel arm was 2.2% versus 0.3% in the control arm. Among patients receiving anthracyclines, the rate of CHF was 3.8% for bevacizumab treated patients and 0.6% for patients receiving paclitaxel alone. Congestive heart failure occurred in six of 44 (14%) patients with relapsed acute leukemia (a non-FDA approved indication) receiving bevacizumab and concurrent anthracyclines in a single arm study. The safety of continuation or resumption of bevacizumab in patients with cardiac dysfunction has not been studied.^[Ref]

Nervous system

• Very common (10% or more): Dizziness (up to 26%), sensory neuropathy (24%)
• Common (1% to 10%): Confusion, abnormal gait, CNS hemorrhage, cerebrovascular ischemia
• Rare (less than 0.1%): Brain-capillary leak syndrome (reversible posterior hyponatremia
• Frequency not reported: Dysgeusia^[Ref]

hypertensive encephalopathy

RPLS is a neurological disorder associated with hypertension, fluid retention, and cytotoxic effects of immunosuppressive drugs on the vascular endothelium. The syndrome can present with headache, seizure, lethargy, confusion, blindness and other visual and neurologic disturbances. Mild to severe hypertension may be present, but is not necessary for diagnosis. The onset of symptoms has been reported to occur from sixteen hours to one year after initiation of bevacizumab. Magnetic resonance imaging is necessary to confirm the diagnosis of RPLS.^[Ref]

Hematologic

• Very common (10% or more): Leukopenia (37%), neutropenia (21%)
• Common (1% to 10%): Thrombocytopenia
• Frequency not reported: Hemorrhagic events, pancytopenia, febrile neutropenia, decreased hemoglobin, anemia, prothrombin time prolongations, infection with severe neutropenia^[Ref]

Hepatic

• Postmarketing reports: Gallbladder perforation

Metabolic

• Very common (10% or more): Hyperglycemia (up to 26%), hypomagnesemia (up to 24%), hyponatremia (up to 19%), hypoalbuminemia (16%), weight loss (up to 16%), hypokalemia (up to 16%)
• Common (1% to 10%): Bilirubinemia
• Frequency not reported: Increased blood potassium, decreased blood phosphorus, increased blood alkaline phosphatase^[Ref]

Musculoskeletal

• Very common (10% or more): Myalgia (up to 15%)
• Common (1% to 10%): Bone pain, back pain
• Postmarketing reports: Osteonecrosis of the jaw^[Ref]

Genitourinary

• Frequency not reported: Ureteral stricture^[Ref]

Respiratory

• Very common (10% or more): Upper respiratory infection (up to 47%), severe or fatal hemoptysis (up to 31%), epistaxis (up to 35%), dyspnea (up to 26%)
• Frequency not reported: Pulmonary hypertension, fatal pulmonary hemorrhage, nasal septum perforation
• Common (1% to 10%): Voice alteration^[Ref]

Patients with recent hemoptysis (greater than or equal to 1/2 tsp of red blood) should not receive bevacizumab.

In study 6, four of 13 (31%) bevacizumab-treated patients with squamous cell histology and two of 53 (4%) bevacizumab-treated patients with histology other than squamous cell, experienced serious or fatal pulmonary hemorrhage as compared to none of the 32 (0%) patients receiving chemotherapy alone. In study 5, the rate of pulmonary hemorrhage requiring medical intervention for the paclitaxel, carboplatin, plus bevacizumab arm was 2.3% (10 of 427) compared to 0.5% (2 of 441) for the paclitaxel plus carboplatin alone arm. There were seven deaths due to pulmonary hemorrhage reported by investigators in the paclitaxel, carboplatin, plus bevacizumab arm as compared to one in the paclitaxel plus carboplatin alone arm. Generally, these serious hemorrhagic events presented as major or massive hemoptysis without a history of minor hemoptysis during bevacizumab therapy.^[Ref]

Renal

• Very common (10% or more): Proteinuria (up to 36%)
• Uncommon (0.1% to 1%): Nephrotic syndrome^[Ref]

Kidney biopsy of six patients with proteinuria showed findings consistent with thrombotic microangiopathy.

In study 5, patients age 65 and older receiving carboplatin, paclitaxel, and bevacizumab had a greater relative risk for proteinuria as compared to younger patients.^[Ref]

Ocular

• Very common (10% or more): Lacrimation increased
• Postmarketing reports: Cases of serious ocular adverse reactions have been reported following unapproved intravitreal use of this drug compounded from vials approved for IV administration. These reactions included infectious endophthalmitis, intraocular inflammation such as sterile endophthalmitis, uveitis and vitreitis, retinal detachment, retinal pigment epithelial tear, intraocular pressure increased, intraocular hemorrhage (such as vitreous hemorrhage or retinal hemorrhage and conjunctival hemorrhage). Some of these reactions have resulted in various degrees of visual loss, including permanent blindness.^[Ref]

It has been suggested that reduction in macular edema after treatment may have resulted in anatomic changes at the fovea and may have triggered the visual hallucinations.^[Ref]

Dermatologic

• Very common (10% or more): Alopecia (up to 32%)
• Common (1% to 10%): Rash/desquamation, skin ulcer
• Frequency not reported: Exfoliative dermatitis, skin discoloration
• Postmarketing reports: Necrotizing fasciitis^[Ref]

Other

• Very common (10% or more): Asthenia (up to 74%), pain (up to 62%), fatigue (up to 80%), headache (up to 37%), peripheral edema (up to 22%), taste disorder (up to 9%)
• Common (1% to 10%): Infection with an unknown ANC
• Uncommon (0.1% to 1%): Nongastrointestinal fistula formation, infection without neutropenia
• Frequency not reported: Mesenteric venous occlusion, syncope, dehydration, somnolence, polyserositis, polyserositis^[Ref]

Immunologic

• Frequency not reported: Sepsis, wound healing complications, urinary tract infection, positive assays for treatment-emergent anti-bevacizumab^[Ref]

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Further information

Avastin side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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