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Bevacizumab; Uses, Dosage, Side Effects, Drug Interactions

Bevacizumab is a medication used to treat a number of types of cancers and a specific eye disease. For cancer, it is given by slow injection into a vein and used for colon cancer, lung cancer, glioblastoma, and renal-cell carcinoma. For age-related macular degeneration, it is given by injection into the eye.

Mechanism of Action of Bevacizumab

Bevacizumab contains human framework regions with antigen-binding regions of a humanized murine antibody that binds to VEGF. Bevacizumab is produced by recombinant DNA technology in a Chinese hamster ovary mammalian cell expression system in a nutrient medium containing the antibiotic gentamicin and is purified by a process that includes specific viral inactivation and removal steps. Bevacizumab binds VEGF and prevents the interaction of VEGF to its receptors (Flt-1 and KDR) on the surface of endothelial cells. This prevents blood vessel proliferation and in response retardation of metastatic tumor growth occurs.

Indications of Bevacizumab

Cervical cancer
Colorectal cancer
Fallopian tube cancer
Glioblastoma multiforme
Non-small cell lung cancer
Ovarian cancer
Peritoneal cancer
Renal cell carcinoma
Glioblastomas
Metastatic breast cancer
Metastatic colorectal cancers
Metastatic renal cell carcinoma
Recurrent cervical cancer
Nonsquamous non-small cell lung cancer that is locally advanced, cannot be removed by surgery, has metastasized, or has recurred.
Ovarian epithelial, fallopian tube, or primary peritoneal cancer that has recurred. This use is approved for the Avastin brand of bevacizumab.
Renal cell carcinoma (a type of kidney cancer) that has metastasized.
Nonsquamous cell non-small cell lung cancer
Recurrent platinum drug resistant fallopian tube cancer
Recurrent platinum drug resistant ovarian cancer
Recurrent platinum drug resistant primary peritoneal cancer
Recurrent, IV-B cervical cancer
Refractory cervical cancer

Contra-Indications of Bevacizumab

Defective internal secretion of ovaries
The decrease of neutrophils in the blood from cancer chemotherapy
Decreased neutrophils a type of white blood cell
High blood pressure
Heart attack
Angina
Chronic heart failure
Transient ischemic attack
Obstruction of a blood vessel by a blood clot
Bleeding
Inflammation of the esophagus with erosion
An abnormal connection between esophagus and windpipe
Abscess within the abdomen
Gastrointestinal fistula
Nephrotic syndrome
Recent operation
Elevation of proteins in the urine
Impaired wound healing
Pregnancy
A mother who is producing milk and breastfeeding
A Rupture in the Wall of the Stomach or Intestine
Problems with post-surgery wound healing
Brain-capillary leak syndrome
The new abnormal connection between two body organs
Secondary ovarian failure

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Dosage of Bevacizumab

Strengths: 25 mg/mL

Colorectal Cancer

In combination with bolus-IFL: 5 mg/kg IV every 2 weeks
In combination with FOLFOX4: 10 mg/kg IV every 2 weeks
In combination with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line bevacizumab-containing regimen: 5 mg/kg IV every 2 weeks or 7.5 mg/kg IV every 3 weeks

Duration of therapy: Until disease progression or unacceptable toxicity

Non-Small Cell Lung Cancer

In combination with carboplatin and paclitaxel: 15 mg/kg IV every 3 weeks
Administer the first infusion over 90 minutes, the second over 60 minutes if the first infusion is tolerated, and all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.
Duration of therapy: Until disease progression or unacceptable toxicity

Renal Cell Carcinoma

In combination with interferon alfa: 10 mg/kg IV every 2 weeks
Administer the first infusion over 90 minutes, the second over 60 minutes if the first infusion is tolerated, and all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.
Duration of therapy: Until disease progression or unacceptable toxicity

Cervical Cancer

In combination with paclitaxel and cisplatin OR paclitaxel and topotecan: 15 mg/kg IV every 3 weeks
Administer the first infusion over 90 minutes, the second over 60 minutes if the first infusion is tolerated, and all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Side Effects of Bevacizumab

The most common

More common

Fast or irregular heartbeat
appetite loss
changes in nails
constipation
fatigue
fever
Back pain
dizziness
headache
increased cough
Acid or sour stomach
decreased appetite
Agitation
chest congestion
chest pain
cold sweats
confusion
decreased sexual ability or desire
stomach or abdominal cramps, gas, or pain
trouble sleeping

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Less common

bleeding gums
blood in the urine or stools
chest pain
diarrhea
Burning, crawling, itching, numbness, prickling, “pins and needles“, or tingling feelings
difficulty in moving
feeling of warmth
muscle stiffness
redness of the face, neck, arms and occasionally, upper chest
sudden sweating
lack or loss of strength
muscle spasm
difficult or labored breathing
difficulty in swallowing
dry mouth
fever
headache
hoarseness
increased blood pressure

Drug Interactions of Bevacizumab

Bevacizumab may interact with following drugs, supplements & may decrease the efficacy of the drug

bacillus Calmette-Guérin (BCG)
belimumab
bisphosphonates (e.g., alendronate, etidronate)
cancer medications (e.g., carboplatin, cyclophosphamide, doxorubicin, ifosfamide)
clonazipe
dipyrone
sunitinib
infliximab
mycophenolate
other medications to treat cancer (e.g., carboplatin, cyclophosphamide, doxorubicin, ifosfamide, vincristine)
sirolimus
tacrolimus
beclomethasone, inhaled
cholera vaccine
daclizumab
denosumab
dichlorphenamide
fingolimod
paclitaxel
paclitaxel protein-bound

Pregnancy & Lactation of Bevacizumab

FDA Pregnancy Category C

Pregnancy

This medication may affect a baby’s development in the womb and should not be used during pregnancy. It is strongly recommended that women who may become pregnant take proper contraceptive measures (e.g., use of a condom) for at least 6 months after the last dose of bevacizumab.

Lactation

It is not known if bevacizumab passes into breast milk. Women should avoid breastfeeding while taking bevacizumab and should not breastfeed for 6 months after stopping treatment.