Drug Interaction Report

GENERALLY AVOID: Coadministration of bevacizumab and anthracyclines may increase the risk of cardiac dysfunction. Bevacizumab and anthracyclines are individually cardiotoxic and may have additive effects during coadministration. Among patients who received prior anthracycline treatment, the incidence of congestive heart failure (CHF) was 4% for patients receiving bevacizumab with chemotherapy compared to 0.6% for patients receiving chemotherapy alone. In previously untreated patients with hematologic malignancy, the proportion of patients with a decline in left ventricular ejection fraction (LVEF) from baseline of 20% or more or a decline from baseline of 10% to less than 50%, was 10% in patients receiving bevacizumab with anthracycline-based chemotherapy compared to 5% in patients receiving the same chemotherapy regimen alone.

MANAGEMENT: Bevacizumab is not indicated for use with anthracycline-based chemotherapy. Some authorities recommend avoiding bevacizumab during and for at least 12 months after stopping anthracycline-containing treatment.

MONITOR: The concomitant or sequential administration of multiple antineoplastic agents may result in additive toxicities, particularly in the bone marrow, gastrointestinal tract and heart.

MANAGEMENT: Close clinical and laboratory monitoring for hematologic and nonhematologic toxicities are recommended when antineoplastic agents are administered concurrently or during close intervals. Dosing adjustments may be necessary. The manufacturers' recommendations and institutional protocols for dosage, treatment regimens, monitoring, and management of toxicities should be consulted.