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Bevacizumab

(bev-uh-sih-zuh-mab)

Trade/other name(s): Avastin

Why would this drug be used?

This drug is used to treat colorectal, kidney, cervical, and non-small cell lung cancers, and certain brain tumors. It may also be used to treat other conditions.

How does this drug work?

Bevacizumab is a type of targeted therapy known as a monoclonal antibody. A monoclonal antibody is a man-made version of an immune system protein that fits like a lock and key with a certain protein in the body.

Bevacizumab attaches to a protein called vascular endothelial growth factor (VEGF), which is required by the body to grow blood vessels. It is thought that by doing this, the drug stops tumors from being able to create new blood vessels to feed the tumor. This limits the tumors’ supply of nutrients, which in turn may slow or stop their growth. For this reason, bevacizumab is sometimes referred to as an anti-angiogenic drug. Another theory is that it may help by making tumor blood vessels (which are usually leaky) more stable, allowing chemotherapy to get into cancer cells more effectively.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have ever had heart disease, stroke, or blood clots in the legs or lungs. This drug may further raise your risk of stroke, heart attack, or other heart or blood vessel problems (see “Precautions” below). The risk of clots is also higher in people who are diabetic or older than 65.
  • If you have ever had a transient ischemic attack or TIA (symptoms similar to stroke, with trouble moving or speaking, which go away within a few hours). This drug may raise your risk of TIA and similar brain problems, including bleeding in the brain.
  • If you have ever coughed up blood or had serious bleeding. This drug may raise your risk of bleeding in the lung, brain, intestine, uterus, or other sites.
  • If you have ever had congestive heart failure, radiation to the chest, or if you have ever had anthracycline drugs such as doxorubicin (Adriamycin), daunorubicin (Cerubidine, Daunomycin), epirubicin (Ellence), or mitoxantrone (Novantrone). This drug may raise your risk of heart failure, even further (see “Precautions” below).
  • If you ever had high blood pressure. This drug may raise your risk of developing uncontrolled high blood pressure (see “Precautions” below).
  • If you have ever had any other medical conditions such as kidney disease, liver disease (including hepatitis), diabetes, gout, or infections. Your doctor may need to monitor you more closely during treatment.
  • If you have had any type of surgery in the past month, or if you are planning to have surgery. This drug can interfere with wound healing (see “Precautions” below).
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of birth defects if a woman takes this drug during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breastfeeding. It is not known whether this drug passes into breast milk. If it does, it may affect the baby. Breastfeeding should be stopped during treatment and for several months afterward.
  • If you think you might want to have children in the future. This drug may reduce fertility (see “Precautions” below). Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If used along with chemotherapy drugs known as anthracyclines, such as doxorubicin (Adriamycin), daunorubicin (Cerubidine, Daunomycin), epirubicin (Ellence), or mitoxantrone (Novantrone), this drug may increase the risk of congestive heart failure.

Bevacizumab may cause irinotecan (Camptosar) to stay in the body longer, and may raise your risk of severe diarrhea.

Bevacizumab given with carboplatin (Paraplatin) and paclitaxel (Taxol) may cause less paclitaxel to stay in the body. This may keep paclitaxel from working as it should.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with bevacizumab. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) and many others
  • Warfarin (Coumadin)
  • Dabigatran (Pradaxa)
  • Clopidogrel (Plavix)
  • Ticlopidine (Ticlid)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Any type of heparin injections

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren’t sure what’s in the medicines you take.

No other serious interactions with other drugs are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Bevacizumab is given as an infusion into a vein. It is usually given once every 2 or 3 weeks. The first treatment is usually given over 90 minutes. If you have no major problems, the next one may be given over 60 minutes. If there are no problems with this, later treatments may be given over 30 minutes. The dose depends on your weight and what the drug is being used for.

Precautions

This drug can cause infusion reactions in some people when the drug is given, especially during and right after the first treatment. Symptoms can include high blood pressure, headaches, chest pain, wheezing, chills, and sweating. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

This drug can affect your body’s ability to heal wounds. Bevacizumab should not be used within at least 28 days (before or after) surgery. It can cause the surgical wound not to heal, or to open back up. It can also cause severe skin infections (necrotizing fasciitis).

This drug can cause bleeding, especially coughing up blood. This has been seen more often in patients with lung cancer, especially a type known as squamous non-small cell lung cancer. Call your doctor right away if you cough up blood. Nosebleeds are also more likely, and in rare cases have been serious. Bleeding in the brain and heavy menstrual bleeding have also been reported. Be sure your doctor knows if you take any medicines that may affect your body’s ability to stop bleeding (see “Drug interactions” section). Tell your doctor right away if you have unusual bruising, nosebleeds, unexpected or severe vaginal bleeding, bleeding gums when you brush your teeth, vomit that is bloody or looks like coffee grounds, rectal bleeding, or black, tarry stools.

This drug may raise your risk of problems due to blood clots, including heart attacks, strokes, and blood clots in the lungs, legs, or arms even if you are on medicine to thin the blood (anti-coagulation). Tell your doctor right away if you have chest pain, shortness of breath, sudden sweating, lightheadedness, vision changes, trouble speaking or moving, or swelling, pain, redness, or warmth in an arm or leg.

This drug may cause congestive heart failure, especially in people who have received radiation to the chest or chemotherapy drugs called anthracyclines, such as doxorubicin (Adriamycin), daunorubicin (Cerubidine, Daunomycin), epirubicin (Ellence), or mitoxantrone (Novantrone). Tell your doctor or nurse right away if you have trouble breathing (shortness of breath), a new cough, rapid weight gain, or swelling around your eyes, in your hands or feet, or in your abdomen.

In rare cases, this drug can cause a hole (perforation), a passageway between organs that isn’t supposed to be there (fistula), or an abscess in the intestines. Fistulas can also happen in the breathing and swallowing tubes, or in the vagina, kidney, bladder, or other places in the body. Any of these might require surgery to correct, or could even be life threatening. It is important to tell your doctor or nurse right away if you develop stomach (abdominal) pain, nausea, vomiting, constipation, fever, or any type of unusual bleeding.

This drug may cause high blood pressure or make it worse. If you’re taking a drug for high blood pressure, talk to your doctor about this. Your blood pressure will be checked before and between treatments, and you may need medicine to help control it if it goes up. If you develop severe high blood pressure, it may not go back to normal after you stop bevacizumab. Tell your doctor right away if notice any possible symptoms of high blood pressure, including a severe headache, chest pain, or feeling dizzy or light-headed.

Bevacizumab may damage your kidneys, which can cause protein in the urine (proteinuria). Your urine will be checked for this before and during treatment. If the amount of protein is high, your doctor may stop your treatment until your kidneys are working better and less protein is found in your urine.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for lab tests and doctor visits.

This drug may lower your white blood cell count. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, new cough, or bringing up sputum. Your doctor will likely prescribe medicines for you to take during and after treatment to help prevent certain infections.

In rare cases, this drug may cause a condition of the nerves known as reversible posterior leukoencephalopathy syndrome (RPLS). Symptoms may include feeling sleepy or confused, headaches, vision problems (including blindness), or seizures. Call your doctor right away if you have any of these symptoms.

When given with chemotherapy to women before menopause, this drug can cause the ovaries to stop working (ovarian failure). This leads to menstrual periods stopping or getting irregular, and an inability to become pregnant. Some women have symptoms much like menopause, such as hot flashes. Although this can get better in some cases, long term effects of this drug on fertility are not known. Women who may want to get pregnant after treatment need to know that it may not be possible after treatment with this drug.

In rare cases, this drug can damage the bones in the jaw, a condition called osteonecrosis of the jaw (ONJ). Your doctor may recommend that you get a thorough dental exam before starting treatment with this drug. While you are getting treatment, be sure to check with your doctor before having any dental procedures done. Tell your doctor if you notice loose teeth, swollen gums, or pain or numbness in your jaw.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • High blood pressure*
  • Headache
  • Mouth sores
  • Nosebleed*
  • Diarrhea
  • Bleeding from the rectum*
  • Loss of appetite
  • Feeling tired
  • Feeling weak
  • Dry skin
  • Red, scaly, or peeling skin
  • Back pain
  • Ovarian failure (when given with chemotherapy)*

Less common

  • Blood clots in the arm, leg, or lung*
  • Low white blood cell count with increased risk of infection*
  • Protein in the urine*
  • Shortness of breath
  • Constipation
  • Abdominal pain
  • Runny nose
  • Change in the way things taste
  • Nausea and/or vomiting

Rare

  • Stroke or heart attack*
  • Hole in the intestines (bowel perforation)*
  • Formation of an abnormal passageway between organs (fistula)*
  • Slow healing of a wound or surgical incision (or re-opening of one that is healing)*
  • Severe skin infection (necrotizing fasciitis)*
  • Bleeding in the lungs, brain, or in other parts of the body*
  • Kidney damage, which may not improve after treatment is stopped*
  • Congestive heart failure with shortness of breath and swelling, especially feet and legs*
  • Nervous system problems, with sleepiness, confusion, trouble with vision, or seizures*
  • Rash, which may be severe
  • Infusion reaction, with headache, chest pain, wheezing, sweating, or chills*
  • Damage to the jawbone (osteonecrosis of the jaw)*
  • Death due to holes or bleeding in the intestine, bleeding in the lung, stroke, heart attack, infection, and other causes*

*See “Precautions” section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2004

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 03/26/2014
Last Revised: 08/15/2014