Bevacizumab

BEVACIZUMAB (AVASTIN) — CLINICIAN SUMMARY

🔴 RED FLAG (IMPORTANT) INFORMATION

(Main things to consider when using this drug)

• High risk of bleeding and GI perforation → stop permanently if perforation or serious haemorrhage occurs.

• Impaired wound healing → withhold before surgery and restart only once wounds are fully healed.

• Hypertension is common → monitor BP regularly; treat aggressively.

• Proteinuria and nephrotic syndrome → check urine protein before and during treatment.

• Arterial thromboembolic events (MI, stroke) → higher risk in older patients and those with vascular disease.

• Reversible posterior leukoencephalopathy syndrome (RPLS) → new headaches, seizures, confusion require immediate discontinuation.

• Not interchangeable with biosimilars without confirmation of indication and dosing.

🔹 1. Basic Information

Generic name: Bevacizumab
Brand name: Avastin
Drug class: Anti-VEGF monoclonal antibody (angiogenesis inhibitor)
Formulation: Concentrate for solution for IV infusion
Route: Intravenous infusion only

Mechanism of action:
Binds vascular endothelial growth factor (VEGF) → inhibits tumour angiogenesis → reduces tumour blood supply and growth.

🔹 2. Indications (FULL – As per Approved PI)

Metastatic Colorectal Cancer

• In combination with fluoropyrimidine-based chemotherapy for metastatic adenocarcinoma of the colon or rectum

Breast Cancer

• First-line treatment of locally recurrent or metastatic adenocarcinoma of the breast:

  • In combination with paclitaxel

• First-line treatment of metastatic breast cancer:

  • In combination with capecitabine when other chemotherapy options (taxanes or anthracyclines) are not appropriate

Non-Small Cell Lung Cancer (NSCLC)

• First-line treatment of unresectable advanced, metastatic or recurrent adenocarcinoma of the lung:

  • In combination with platinum-based chemotherapy

• First-line treatment of non-squamous NSCLC with EGFR-activating mutations:

  • In combination with erlotinib

Renal Cell Carcinoma

• First-line treatment of advanced or metastatic renal cell carcinoma:

  • In combination with interferon alfa-2a

Ovarian, Fallopian Tube and Primary Peritoneal Cancer

• First-line treatment:

  • In combination with carboplatin and paclitaxel

• Platinum-sensitive recurrent disease:

  • In combination with carboplatin and gemcitabine or carboplatin and paclitaxel

• Platinum-resistant recurrent disease (≤2 prior regimens):

  • In combination with paclitaxel, topotecan, or pegylated liposomal doxorubicin

Cervical Cancer

• Persistent, recurrent, or metastatic carcinoma of the cervix:

  • In combination with paclitaxel and cisplatin or paclitaxel and topotecan

Glioblastoma (WHO Grade IV)

• Newly diagnosed glioblastoma:

  • In combination with radiotherapy and temozolomide

• Recurrent or progressive glioblastoma:

  • As monotherapy or with irinotecan

🔹 3. Dosing & Administration

• Dose and schedule depend on indication and combination regimen

• Administered as IV infusion

• Initial infusion over 90 minutes, then 60 minutes, then 30 minutes if well tolerated

• Do not administer as IV bolus or push

🔹 4. Dose Modifications

• No dose reductions recommended

• Manage toxicity by withholding or discontinuing treatment

Permanently discontinue for:

• GI perforation

• Severe bleeding

• Arterial thromboembolic events

• RPLS

• Nephrotic syndrome

🔹 5. Co-medications / Interactions

Commonly used with:

• Fluoropyrimidines

• Platinum agents

• Paclitaxel

• Gemcitabine

• Temozolomide

• Erlotinib

• Interferon alfa

Use caution with:

• Anticoagulants and antiplatelet agents

• Other drugs increasing bleeding risk

🔹 6. Contraindications

• Hypersensitivity to bevacizumab or excipients

• Pregnancy and breastfeeding

• Untreated CNS bleeding

• Recent major surgery with unhealed wounds

🔹 7. Monitoring Requirements

Baseline and ongoing:

• Blood pressure

• Urine protein (dipstick or UPC ratio)

• Renal function

• Signs of bleeding or thrombosis

• Wound healing status

• Neurological symptoms (RPLS)

🔹 8. Side Effects (Clinically Relevant)

Common:

• Hypertension

• Proteinuria

• Fatigue

• Diarrhoea

• Epistaxis

Serious:

• Gastrointestinal perforation

• Severe haemorrhage

• Arterial thromboembolism

• Nephrotic syndrome

• RPLS

• Wound dehiscence

🔹 9. Use in Special Populations

Elderly:

• Increased thromboembolic risk

Renal impairment:

• Monitor closely for proteinuria

Hepatic impairment:

• No dose adjustment required

🔹 10. Duration of Use / When to Stop

Continue until:

• Disease progression, or

• Unacceptable toxicity

Permanently discontinue for:

• Life-threatening bleeding

• GI perforation

• Arterial thrombotic events

• RPLS

• Nephrotic syndrome

https://pi-pil-repository.sahpra.org.za/wp-content/uploads/2023/02/Avastin-PI_19Apr2022.pdf