Bevacizumab

Bevacizumab treats certain types of cancer. This medication is associated with ovarian failure that can mimic the symptoms of early menopause and decrease fertility.

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Pharmacist Trey Robinson, PharmD overviews the uses and common side effects of Bevacizumab
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Bevacizumab Overview

Updated: 

Bevacizumab is a prescription medication used to treat symptoms of Glioblastoma (GBM), a fast growing brain tumor. It is also used to treat symptoms of colon cancer, colorectal cancer, cervical cancer, lung cancer, ovarian, or renal cell cancer (a type of cancer that begins in the kidney). Bevacizumab belongs to a group of drugs called antiangiogenic agents, which stops blood vessels that feed tumors from forming.

This medication comes in a liquid form and is injected intravenously (into a vein) by your doctor or healthcare provider. You will most likely receive an injection every 2 or 3 weeks.

Common side effects of bevacizumab include nosebleeds, headache, and high blood pressure. 

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Bevacizumab Cautionary Labels

Uses of Bevacizumab

Bevacizumab is approved by the the U.S. Food and Drug Administration (FDA) to be used alone or with other medicines to treat:

  • Glioblastoma (GBM), a fast-growing brain tumor, that has not gotten better with other types of treatment.

Bevacizumab is also approved to be used with other medicines to treat the following types of cancer:

  • colon (large intestine) cancer that has metastasized (spread to other parts of the body)
  • metastatic colorectal cancer (mCRC) that has worsened in patients who were already treated once with bevacizumab plus other chemotherapy medications to be treated again with bevacizumab in combination with a different chemotherapy regimen.
  • certain types of lung cancer, that cannot be removed by surgery, has metastasized, or has recurred (come back).
  • renal Cell Cancer (RCC), a type of cancer that begins in the kidney, that has metastasized. 
  • persistent, recurrent or late-stage (metastatic) cervical cancer.
  • platinum-resistent, recurrent ovarian cancer.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Bevacizumab Drug Class

Bevacizumab is part of the drug class:

Side Effects of Bevacizumab

Serious side effects have been reported with bevacizumab. See the “Bevacizumab Precautions” section.

The most common side effects of bevacizumab are:

  • nosebleeds
  • headache
  • high blood pressure
  • inflammation of the nose
  • too much protein in the urine
  • changes in taste sensation
  • dry skin
  • rectal bleeding
  • tear production disorder
  • back pain
  • skin inflammation

This is not a complete list of bevacizumab side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

 

Bevacizumab Interactions

No bevacizumab drug interactions have been identified, however, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Bevacizumab Precautions

Bevacizumab can cause serious side effects. See "Bevacizumab FDA Warning."

The most serious side effects that can occur with bevacizumab treatment are:

  • a hole develops in the stomach or intestine (gastrointestinal perforation). Call your doctor right away if you have stomach pain, constipation, nausea (upset stomach), vomiting, or fever. This is a serious, possibly life-threatening condition.
  • a surgical wound (cut) that won't heal. Call your doctor right away if you experience this problem. Don't take bevacizumab for at least 28 days before or after surgery and until surgical wounds are fully healed.
  • serious bleeding (coughing or vomiting blood). This condition can be life-threatening. Call your doctor right away if you have nosebleeds, if your gums bleed, or if you cough up blood or vomit blood.
  • increased the risk of high blood pressure, congestive heart failure (CHF), strokes, heart attacks, chest pain, and transient ischemic attacks (TIAs, or "mini-strokes"). Tell your doctor if you have heart disease or if you have every had any of these conditions.

These most serious side effects are rare, but can be fatal.

Other possible side effects include:

  • abnormal passage in the body from one part of the body to another (can be fatal)
  • stroke or other heart problems
  • severely high blood pressure
  • vision problems
  • kidney problems
  • ovaries stop working
  • infusion reactions involving breathing problems, chest pain, and excessive sweating

Do not receive bevacizumab if you are allergic to any ingredient in it. Tell your doctor if you are allergic to any medication.

Bevacizumab Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of bevacizumab there are no specific foods that you must exclude from your diet when receiving bevacizumab.

Inform MD

Tell your doctor if you are allergic to any ingredient in bevacizumab.

Tell your doctor about all of your medical conditions, including if you:

  • have high blood pressure (hypertension)
  • have heart disease (history of heart attack, stroke, blood clot, congestive heart failure)
  • have kidney disease
  • have any infection or fever
  • are planning to have surgery
  • are pregnant or breastfeeding

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Bevacizumab and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Bevacizumab and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if bevacizumab is excreted in human breast milk or if it will harm your nursing baby.

Bevacizumab Usage

Bevacizumab comes as a liquid to be injected intravenously (into a vein) by your doctor or healthcare provider in a medical setting (hospital or clinic). The first injection will last 90 minutes. You will likely receive an injection every 2 or 3 weeks. If the first dose is received with no serious side effects, the remaining doses may be given over 30 to 60 minutes.

Bevacizumab is usually given either once every 2 weeks, or once every 3 weeks, depending upon the condition being treated.

Depending on how your body responds, your doctor may delay or stop your bevacizumab treatments.

Bevacizumab Dosage

Your doctor will determine how much bevacizumab you will receive and how often you will receive it based on your weight and the condition being treated.

For the treatment of glioblastoma, a brain cancer, bevacizumab is usually given every 2 weeks.

For the treatment of certain types of colon, and kidney cancers, bevacizumab is usually given every 2 weeks in combination with other cancer medicines.

For the treatment of certain types of lung and cervical cancer, bevacizumab is usually given every 3 weeks in combination with other cancer medicines.

For the treatment of ovarian cancer that is resistant to platinum medications, bevacizumab is usually given every 2 or 3 weeks and will depend on what other medications are given in combination with bevacizumab. 

Bevacizumab Overdose

If bevacizumab is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Other Requirements

Keep all medical and laboratory appointments. To get the most benefit, you should receive bevacizumab doses as scheduled. If you miss an appointment, reschedule as soon as possible. 

Bevacizumab FDA Warning

Gastrointestinal Perforations

Bevacizumab administration can result in the development of gastrointestinal perforation, in some instances resulting in fatality.

  • Gastrointestinal perforation, sometimes associated with intra-abdominal abscess, occurred throughout treatment with bevacizumab (i.e., was not correlated to duration of exposure).
  • The incidence of gastrointestinal perforation (gastrointestinal perforation, fistula formation, and/or intra-abdominal abscess) in patients with colorectal cancer and in patients with non-small cell lung cancer (NSCLC) receiving bevacizumab was 2.4% and 0.9%, respectively. The typical presentation was reported as abdominal pain associated with symptoms such as constipation and vomiting.
  • Gastrointestinal perforation should be included in the differential diagnosis of patients presenting with abdominal pain on bevacizumab.
  • Bevacizumab therapy should be permanently discontinued in patients with gastrointestinal perforation.

Wound Healing Complications

  • Bevacizumab administration can result in the development of wound dehiscence, in some instances resulting in fatality.
  • Bevacizumab therapy should be permanently discontinued in patients with wound dehiscence requiring medical intervention.
  • The appropriate interval between termination of bevacizumab and subsequent elective surgery required to avoid the risks of impaired wound healing/wound dehiscence has not been determined.

Hemorrhage

  • Fatal pulmonary hemorrhage can occur in patients with non-small cell lung cancer treated with chemotherapy and bevacizumab.
  • Incidence: The incidence of serious or fatal hemoptysis was 31% in patients with squamous histology and 2.3% in patients with NSCLS excluding predominant squamous histology.
  • Patients with recent hemoptysis (at least one-half teaspoonful of red blood) should not receive bevacizumab.