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
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
- chest pain
- a headache
- joint painPain
- dizziness
- nausea and vomiting
- Severe stomach ache
- epigastric pain,
- diarrhea,
- anorexia,
- flatulence,
- a headache,
- dizziness,
- fainting, fast or pounding heartbeats.
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
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.
References
