Bevacizumab Dosage

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:
-Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
-Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
-First infusion: Administer infusion over 90 minutes.
-Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:
-For the first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum in combination with IV 5-fluorouracil-based chemotherapy.
-For the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line bevacizumab-containing regimen, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy.
-Limitation of Use: This drug is not indicated for adjuvant treatment of colon cancer.

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

Comments:
-Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
-Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
-First infusion: Administer infusion over 90 minutes.
-Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:
-For the first-line treatment of unresectable, locally advanced, recurrent or
34 metastatic non-squamous non-small cell lung cancer in combination with carboplatin and paclitaxel.

Usual Adult Dose for Glioblastoma Multiforme

Recommended dose: 10 mg/kg every 2 weeks

Comments:
-Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
-Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
-First infusion: Administer infusion over 90 minutes.
-Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:
-For the treatment of glioblastoma with progressive disease in adult patients following prior therapy as a single agent. The effectiveness of bevacizumab in glioblastoma is based on an improvement in objective response rate. There are no data demonstrating an improvement in disease-related symptoms or increased survival with bevacizumab.

Usual Adult Dose for Cervical Cancer

15 mg/kg IV every 3 weeks

Comments:
-Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
-Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
-First infusion: Administer infusion over 90 minutes.
-Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:
-For the treatment of persistent, recurrent, or metastatic carcinoma of the cervix in combination with paclitaxel and cisplatin or paclitaxel and topotecan.

Usual Adult Dose for Renal Cell Carcinoma

10 mg/kg IV every 3 weeks

Comments:
-Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
-Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
-First infusion: Administer infusion over 90 minutes.
-Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:
-For the treatment of metastatic renal cell carcinoma in combination with interferon alfa.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

There are no recommended dose reductions for the use of bevacizumab. If needed, bevacizumab should be either discontinued or temporarily suspended.

Precautions

-Do not give as an IV bolus injection.
-Bevacizumab should be permanently discontinued in patients who develop gastrointestinal perforation, wound dehiscence requiring medical intervention, serious bleeding, nephrotic syndrome, or hypertensive crisis.
-Temporary suspension of bevacizumab is recommended in patients with evidence of moderate to severe proteinuria pending further evaluation and in patients with severe hypertension that is not controlled with medical management. The risk of continuation or temporary suspension of bevacizumab in patients with moderate to severe proteinuria is unknown.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-The first dose of bevacizumab should be infused over 90 minutes following chemotherapy. If it is well tolerated, the second dose may be infused over 60 minutes. If the 60 minute infusion is well tolerated, all subsequent doses may be infused over 30 minutes.
-Bevacizumab should not be administered as an IV push or bolus.

Reconstitution/preparation techniques:
-The manufacturer's product information should be consulted; bevacizumab should be diluted in 0.9% sodium chloride solution.
-Bevacizumab should not be administered or mixed with glucose solutions.

Storage requirements: Bevacizumab vials should be refrigerated at 2 to 8 degrees Celsius. Diluted preparations may be kept for up to 24 hours if stored under refrigeration at 2 to 8 degrees Celsius.

General:
-Bevacizumab therapy should not be initiated for at least 28 days following major surgery. If the patient has had surgery, the surgical incision should be fully healed prior to initiation of bevacizumab.
-Bevacizumab should be prepared, administered, and disposed of according to standard protocols for antineoplastic drugs.
-Bevacizumab as presented in the marketed product Avastin (R) is not formulated for intravitreal use.

Monitoring:
-Hypersensitivity: Infusion-related reactions
-Cardiovascular: Blood pressure monitoring for hypertension
-Renal: Proteinuria
-Signs and symptoms of adverse effects, including: Arterial or venous thromboembolic events, gastrointestinal perforations and fistulae, delayed wound healing, hemorrhage (including tumor-associated hemorrhage), congestive heart failure, neutropenia, osteonecrosis of the jaw, and reversible posterior leukoencephalopathy syndrome.