Bevacizumab

Bevacizumab Brand Names

Avastin | MVASI | Zirabev

What is Bevacizumab

Bevacizumab is a vascular endothelial growth factor (VEGF)-directed monoclonal antibody.

Vascular targeting therapies are aimed at inhibiting tumor neovascularization and are not directly cytotoxic; therefore, bevacizumab is typically used in combination with traditional cytotoxic treatment modalities.

Bevacizumab is indicated for the treatment of colorectal cancer; non-small cell lung cancer; glioblastoma; renal cell carcinoma; cervical cancer; and epithelial ovarian, fallopian tube, or primary peritoneal cancer. It is not indicated for adjuvant treatment of colon cancer.

Bevacizumab-awwb and bevacizumab bvzr, both biosimilars, are FDA-approved for the same indications as bevacizumab, with the exception that they are not approved for use in epithelial ovarian, fallopian tube, or primary peritoneal cancer.

Bevacizumab has been studied as an intravitreal injection for diabetic retinopathy and the wet form of age-related macular degeneration (AMD), as a cost-effective alternative when patients are not responsive to other therapies.

In 2008, bevacizumab with paclitaxel was granted FDA-approval for previously untreated metastatic HER2-negative breast cancer based on an improvement in progression-free survival; however, an improvement in overall survival was not demonstrated.

The FDA rescinded this approval in 2011 after reviewing the results of 4 clinical studies of bevacizumab in breast cancer and determining a lack of prolonged overall survival and a lack of sufficient benefit in slowing disease progression relative to the significant risks of the drug.

Bevacizumab is associated with potentially severe infusion-related reactions; a reduced infusion rate, interruption of therapy, or discontinuation of therapy may be necessary.

Additionally, patients should not receive bevacizumab for 28 days before and after elective surgery due to wound healing complications associated with treatment.

Indications

  1. breast cancer
  2. cervical cancer
  3. colorectal cancer
  4. diabetic macular edema
  5. diabetic retinopathy
  6. glioblastoma multiforme
  7. macular degeneration
  8. mesothelioma
  9. non-small cell lung cancer (NSCLC)
  10. ovarian cancer
  11. renal cell cancer

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. amenorrhea
  4. angina
  5. anorexia
  6. antibody formation
  7. anxiety
  8. arthralgia
  9. asthenia
  10. back pain
  11. biliary fistula
  12. bladder fistula
  13. bleeding
  14. blurred vision
  15. bowel necrosis
  16. bronchopleural fistula
  17. chest pain (unspecified)
  18. chills
  19. confusion
  20. constipation
  21. cough
  22. dehydration
  23. diaphoresis
  24. diarrhea
  25. dizziness
  26. dysarthria
  27. dysphonia
  28. dyspnea
  29. elevated hepatic enzymes
  30. encephalopathy
  31. epistaxis
  32. exfoliative dermatitis
  33. fatigue
  34. gastritis
  35. gastroesophageal reflux
  36. gastrointestinal fistula
  37. GI bleeding
  38. GI perforation
  39. gingivitis
  40. headache
  41. hearing loss
  42. heart failure
  43. hematemesis
  44. hematoma
  45. hemoptysis
  46. hemorrhoids
  47. hyperglycemia
  48. hyperkalemia
  49. hypertension
  50. hypertensive crisis
  51. hypoalbuminemia
  52. hypocalcemia
  53. hypokalemia
  54. hypomagnesemia
  55. hyponatremia
  56. ileus
  57. impaired wound healing
  58. infection
  59. infusion-related reactions
  60. insomnia
  61. intracranial bleeding
  62. lacrimation
  63. lethargy
  64. leukopenia
  65. lymphopenia
  66. metallic taste
  67. myalgia
  68. myocardial infarction
  69. nasal septum perforation
  70. nausea
  71. necrotizing fasciitis
  72. nephrotic syndrome
  73. neutropenia
  74. neutropenia
  75. oral ulceration
  76. osteonecrosis
  77. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  78. pancytopenia
  79. pelvic pain
  80. peptic ulcer
  81. peripheral edema
  82. peripheral neuropathy
  83. pneumonitis
  84. proteinuria
  85. pulmonary embolism
  86. pulmonary hypertension
  87. rhinitis
  88. rhinorrhea
  89. seizures
  90. sinusitis
  91. stomatitis
  92. stroke
  93. syncope
  94. thrombocytopenia
  95. thromboembolism
  96. thrombosis
  97. thrombotic microangiopathy
  98. tinnitus
  99. tracheoesophageal fistula
  100. vaginal bleeding
  101. vaginal fistula
  102. visual impairment
  103. vomiting
  104. weakness
  105. weight loss
  106. wheezing
  107. xerosis

Monitoring Parameters

  • blood pressure
  • urinalysis

Contraindications

  • angina
  • bleeding
  • breast-feeding
  • children
  • contraception requirements
  • dental work
  • diabetes mellitus
  • encephalopathy
  • fistula
  • geriatric
  • GI bleeding
  • GI obstruction
  • GI perforation
  • heart failure
  • hypertension
  • hypertensive crisis
  • impaired wound healing
  • infants
  • infertility
  • infusion-related reactions
  • intracranial bleeding
  • myocardial infarction
  • neonates
  • ovarian cancer
  • ovarian failure
  • pregnancy
  • proteinuria
  • radiation therapy
  • renal impairment
  • reproductive risk
  • stroke
  • surgery
  • thromboembolic disease
  • vaginal bleeding

Interactions

  • Palifermin
  • Panitumumab
  • Penicillamine
  • Solriamfetol
  • Tuberculin Purified Protein Derivative, PPD
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