bevacizumab

High Alert

Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, and Zirabev

Treatment of the following conditions:
- First- or second-line treatment of metastatic colorectal cancer (in combination with IV 5-fluorouracil-based chemotherapy);
- Second-line treatment of metastatic colorectal cancer in patients who have progressed on a first-line regimen containing bevacizumab (in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy);
- First-line treatment of patients with unresectable, locally advanced, recurrent, or metastatic nonsquamous non-small cell lung cancer (in combination with carboplatin and paclitaxel);
- Recurrent glioblastoma (as monotherapy);
- Metastatic renal cell carcinoma (in combination with interferon alfa);
- Persistent, recurrent, or metastatic cervical cancer (in combination with paclitaxel and cisplatin or paclitaxel and topotecan);
- Platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who have received ≤2 previous chemotherapy regimens (in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan).

Avastin, Mvasi, Vegzelma, and Zirabev

Treatment of the following conditions:
- Platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer (in combination with carboplatin and paclitaxel or with carboplatin and gemcitabine);
- Stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgical resection (in combination with carboplatin and paclitaxel followed by bevacizumab as a single agent).

Avastin only

Unresectable or metastatic hepatocellular carcinoma in patients who have not previously received systemic therapy (in combination with atezolizumab).

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Recent hemoptysis or other serious recent bleeding episode;
First 28 days after major surgery;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease;
Diabetes (↑ risk of arterial thromboembolic events);
Previous use of anthracyclines (↑ risk of HF);
Esophageal varices (in patients with hepatocellular carcinoma);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children; cases of nonmandibular osteonecrosis reported;
Geri: ↑risk of serious adverse reactions including arterial thromboembolic events in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: HF, hypertension, hypotension

Derm: impaired wound healing, NECROTIZING FASCIITIS, WOUND DEHISCENCE

EENT: nasal septum perforation

GI: GI PERFORATION

GU: ↑serum creatinine, nephrotic syndrome, ovarian failure, proteinuria

Hemat: BLEEDING, THROMBOEMBOLIC EVENTS

Neuro: POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)

Resp: HEMOPTYSIS

Misc: INFUSION REACTIONS

Interactions ⬆ ⬇

Drug-drug:

↑blood levels of SN 38 (the active metabolite of irinotecan); significance is not known.
↑risk of microangiopathic hemolytic anemia when used with sunitinib; concurrent use should be avoided.

Availability ⬆ ⬇

Solution for injection: 25 mg/mL

Route/Dosage ⬆ ⬇

Colorectal Cancer

IV (Adults ): Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, or Zirabev:5 mg/kg every 14 days when given with bolus-IFL chemotherapy regimen or 10 mg/kg every 14 days when given with FOLFOX4 chemotherapy regimen or 5 mg/kg every 14 days or 7.5 mg/kg every 21 days when given with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen.

Lung Cancer or Cervical Cancer

IV (Adults ): Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, or Zirabev: 15 mg/kg every 3 wk.

Glioblastoma or Renal Cell Carcinoma

IV (Adults ): Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, or Zirabev: 10 mg/kg every 2 wk.

Platinum-Resistant Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

IV (Adults ): Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, or Zirabev:10 mg/kg every 2 wk when given with paclitaxel, pegylated liposomal doxorubicin, or topotecan (weekly) or 15 mg/kg every 3 wk when given with topotecan (every 3 wk).

Platinum-Sensitive Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

IV (Adults ): Avastin, Mvasi, Vegzelma, or Zirabev:15 mg/kg every 3 wk when given with carboplatin and paclitaxel for 6–8 cycles, followed by 15 mg/kg every 3 wk as a single agent or 15 mg/kg every 3 wk when given with carboplatin and gemcitabine for 6–10 cycles, followed by 15 mg/kg every 3 wk as a single agent.

Stage III or IV Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Following Surgical Resection

IV (Adults ): Avastin, Mvasi, Vegzelma, or Zirabev:15 mg/kg every 3 wk when given with carboplatin and paclitaxel for up to 6 cycles, followed by 15 mg/kg every 3 wk as a single agent for a total up to 22 cycles or until disease progression, whichever occurs earlier

Hepatocellular Carcinoma

IV (Adults ): Avastin:15 mg/kg every 3 wk (administer after atezolizumab on same day) until disease progression or unacceptable toxicity.

US Brand Names ⬆ ⬇

Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, Zirabev

Action ⬆ ⬇

A monoclonal antibody that binds to vascular endothelial growth factor, preventing its attachment to binding sites on vascular endothelium, thereby inhibiting growth of new blood vessels (angiogenesis).

Therapeutic effects:

Decreased metastatic disease progression and microvascular growth.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: monoclonal antibodies

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: 20 days (range 11–50 days).

Canadian Brand Names ⬆ ⬇

Abevmy, Aybintio, Bambevi

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	14 days

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of bevacizumab to patient. Do not stop receiving drug without consulting health care professional. If an appointment is missed, contact health care professional as soon as possible to reschedule. Advise patient to read Medication Guidebefore starting and periodically during therapy in case of changes.
Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and may be needed.
Advise patient of the need for monitoring BP periodically during therapy; notify health care professional if BP is elevated.
Advise patient to report any signs of unusual bleeding, high fever, rigors, sudden onset of worsening neurological function, persistent or severe abdominal pain, severe constipation, or vomiting immediately to health care professional.
Inform patient of ↑ risk of wound healing complications and arterial thromboembolic events.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception and avoid breastfeeding during and for 6 mo after last dose. Inform female patient of reproductive potential of risk of ovarian failure that may lead to sterility following therapy.

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Indications ⬇