Avastin (bevacizumab)

AVASTIN (bevacizumab) – a vascular endothelial growth factor-specific angiogenesis inhibitor commonly used to treat certain cancers. Bevacizumab binds VEGF and prevents the interaction of VEGF to its receptors (Flt-1 and KDR) on the surface of endothelial cells. The interaction of VEGF with its receptors leads to endothelial cell proliferation and new blood vessel formation in vitro models of angiogenesis.

FDA approved uses: Avastin is indicated for the treatment of: Metastatic colorectal cancer, with intravenous 5-fluorouracil–based chemotherapy for first- or second-line treatment.; Non-squamous non-small cell lung cancer, with carboplatin and paclitaxel for first line treatment of unresectable, locally advanced, recurrent or metastatic disease; Glioblastoma, as a single agent for adult patients with progressive disease following prior therapy. Effectiveness based on improvement in objective response rate. No data available demonstrating improvement in disease-related symptoms or survival with Avastin; Metastatic renal cell carcinoma with interferon alfa. Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.

Available dosage forms: Injection: 100 mg/4 mL, single use vial; 400 mg/16 mL, single use vial.
Usual dosage: Do not administer as an IV push or bolus. Do not initiate Avastin for 28 days following major surgery and until surgical wound is fully healed. Metastatic colorectal cancer: 5 mg/kg IV every 2 weeks with bolus-IFL 10 mg/kg IV every 2 weeks with FOLFOX4; Non-squamous non-small cell lung cancer: 15 mg/kg IV every 3 weeks with carboplatin/paclitaxel; Glioblastoma 10 mg/kg IV every 2 weeks. Metastatic renal cell carcinoma (mRCC): 10 mg/kg IV every 2 weeks with interferon alfa.

Contraindications: The manufacturer states that there are no contraindications to the product.
Special warnings: The following serious complications have occurred in patients receiving Avastin – Gastrointestinal Perforation: Occurs in up to 2.4% of Avastin-treated patients. Discontinue Avastin for gastrointestinal perforation. Surgery and Wound Healing Complications: Discontinue in patients with wound dehiscence. Discontinue at least 28 days prior to elective surgery. Do not initiate Avastin for at least 28 days after surgery and until the surgical wound is fully healed. Hemorrhage: Severe or fatal hemorrhage, hemoptysis, gastrointestinal bleeding, CNS hemorrhage, and vaginal bleeding are increased in Avastin- treated patients. Do not administer Avastin to patients with serious hemorrhage or recent hemoptysis.

Adverse reactions (side effects) of these medications: The most common side effects of Avastin include epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, back pain and exfoliative dermatitis. Other adverse reactions seen in clinical trials or post-marketing include: pain, abdominal pain, hypotension, deep vein thrombosis, vomiting, anorexia, constipation, stomatitis, dyspepsia, GI hemorrhage, weight loss, dry mouth, colitis, thrombocytopenia, dizziness, upper respiratory infection, dysnpea, voice alteration, alopecia, skin ulcers, leukopenia and neutropenia.

Common drug interactions: There were no clinically significant drug interactions reported in clinical trials of Avastin.

Special instructions for patients: The manufacturer recommends that patents should be advised of the following:

  • To undergo routine blood pressure monitoring and to contact their health care provider if blood pressure is elevated.
  • To immediately contact their health care provider for unusual bleeding, high fever, rigors, sudden onset of worsening neurological function, or persistent or severe abdominal pain, severe constipation, or vomiting.
  • Of increased risk of wound healing complications during and following Avastin.
  • Of increased risk of an arterial thromboembolic event.
  • Of the potential risk to the fetus during and following Avastin and the need to continue adequate contraception for at least 6 months following last dose of Avastin.
  • Of the increased risk for ovarian failure following Avastin treatment. Tablets must be swallowed whole and never split, crushed or chewed.

    • Full prescribing information may be found at the manufacturer‘s official website Avastin.com or at the U.S. Food and Drug Administration’s website at Avastin Info at Drugs@FDA

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