BMA Concise Guide to Medicine & Drugs

Bevacizumab

Brand name Avastin

Used in the following combined preparations None

QUICK REFERENCE

Drug group Anticancer drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Bevacizumab is a monoclonal antibody used in combination with other anticancer drugs for treating advanced cancer of the bowel, breast, lung, ovary, or kidney. It blocks vascular endothelial growth factor (VEGF), a protein produced by cancer metastases that promotes the growth of new blood vessels (angiogenesis). Blocking VEGF inhibits blood vessel growth and deprives metasases of nutrients and oxygen. But bevacizumab does not destroy tumours and the cancer will eventually progress. On average, the drug improves survival for a few months.

A portion of the bevacizumab molecule is marketed separately under the generic name ranibizumab. This has the same anti-angiogenesis properties as bevacizumab and, given by injection into the eye, is used to treat wet age-related macular degeneration.

INFORMATION FOR USERS

This drug is given only under medical supervision and is not for self- administration.

How taken/used Intravenous infusion.

Frequency and timing of doses Once every 2–3 weeks.

Adult dosage range Dosage is determined individually according to the type of cancer and the patient’s body weight.

Onset of effect 4–6 hours.

Duration of action 18–20 days.

Diet advice Bevacizumab can cause nausea and vomiting so it is advisable not to eat or drink for a few hours before treatment.

Storage Not applicable. This drug is not normally kept in the home.

Missed dose If you miss your scheduled dose, contact your doctor as soon as possible.

Stopping the drug Discuss with your doctor. Stopping the drug prematurely may lead to a worsening of the underlying condition.

Exceeding the dose Overdosage is unlikely since treatment is carefully monitored and supervised.

POSSIBLE ADVERSE EFFECTS

Bevacizumab is given only under medical supervision and adverse effects are closely monitored. It frequently causes fatigue and gastrointestinal symptoms, such as diarrhoea, nausea, and vomiting. More serious and rarer side effects include internal bleeding from the cancer (which may cause coughing up of blood or blood on the faeces); abdominal or chest pain; breathlessness; loss of vision; seizures; heart attack; and stroke. Normal wound healing is also impaired. Prolonged use of the drug may also cause blood, circulation, or intestinal problems (see Prolonged use). Any adverse effects should be reported to medical staff immediately.

INTERACTIONS

There are no known significant interactions with other drugs but it is advisable to discuss with your doctor or pharmacist before taking other medications.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a history of colitis or have previously had a bowel perforation or fistula.

· You have recently had major surgery.

· You have high blood pressure, heart failure, or a history of thromboembolism, stroke or heart attacks.

· You have liver or kidney problems.

· You have a blood clotting disorder.

· You are pregnant, planning a pregnancy, or breast-feeding.

· You are taking other medicines, especially anticoagulants.

Pregnancy Must not be used during pregnancy. Women of childbearing age must use contraception during treatment and for up to 6 months afterwards.

Breast-feeding Women must not breast-feed during treatment and for at least six months afterwards.

Infants and children Unlikely to be necessary as the conditions for which the drug is used occur almost exclusively in adults.

Over 60 Increased risk of adverse effects.

Driving and hazardous work No known problems.

Alcohol No known problems.

PROLONGED USE

Prolonged treatment carries an increased risk of developing severe hypertension (high blood pressure), bleeding or blood-clotting problems, and perforation of the bowel. The risk increases with the dose and duration of treatment.

Monitoring You will have blood tests to check your blood cell count and clotting, and regular checks of your blood pressure. Your urine will be tested for protein.