Bevacizumab: Indication, Dosage, Side Effect, Precaution

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Indonesia prescribing information.

Generic Medicine Info

Indications and Dosage

Intravenous
Metastatic breast cancer

Adult: 10 mg/kg once every 2 wk or 15 mg/kg once every 3 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability, in combination w/ paclitaxel.

Intravenous
Non-small cell lung cancer

Adult: 7.5 mg/kg or 15 mg/kg once every 3 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability. Usually in combination w/ carboplatin and paclitaxel.

Intravenous
Advanced renal cell carcinoma, Metastatic renal cell carcinoma

Adult: 10 mg/kg once every 2 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability, in combination w/ interferon alfa.

Intravenous
Metastatic colorectal cancer

Adult: 5 mg/kg or 10 mg/kg once every 2 wk, or 7.5 mg/kg or 15 mg/kg once every 3 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability. Doses depend on drug combination used in the regimen.

Intravenous
Cervical cancer

Adult: 15 mg/kg every 3 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability, in combination w/ paclitaxel/cisplatin or paclitaxel/topotecan.

Intravenous
Glioblastoma

Adult: 10 mg/kg once every 2 wk via infusion over 90 minutes on the 1st dose and may be infused thereafter over 60 or 30 minutes depending on tolerability.

Reconstitution

Dilute in 100 mL of NaCl 0.9%. Final concentration should be 1.4-16.5 mg/mL.

Special Precautions

Patient w/ CV disease, pre-existing HTN, CNS metastases, diabetes, history of arterial thromboembolism; at risk of thrombocytopenia, GI perforation and gall bladder perforation. Discontinue treatment if hypertensive crisis or hypertensive encephalopathy develops. Withhold treatment prior to elective surgery. Do not initiate treatment for at least 28 days after major surgery or until surgical wound is fully healed. Elderly >65 yr. Pregnancy and lactation.

Adverse Reactions

Gall bladder perforation, ileus, intestinal obstruction, hepatobiliary disorder, GI disorder, arterial thromboembolism, HTN, fatigue or asthenia, pyrexia, pain, mucosal inflammation, abdominal pain, diarrhoea, constipation, nausea, vomiting, anorexia, febrile neutropenia, leucopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, dysarthria, headache, dysgeusia, eye disorder, increased lacrimation, venous thromboembolism, dyspnoea, rhinitis, rectal haemorrhage, stomatitis, exfoliative dermatitis, skin discolouration, dry skin, arthralgia, proteinuria, ovarian failure, sepsis, abscess, infection, UTI, anaemia, hypersensitivity infusion reaction, dehydration, CVA, somnolence, syncope, CHF, supraventricular tachycardia, DVT, pulmonary embolism, hypocia, epistaxis, dysphonia, Palmar-plantar erythrodysaesthesia syndrome, fistula, myalgia, muscular weakness, lethargy.
Potentially Fatal: GI perforation, necrotising fasciitis, wound healing and surgical complications, haemorrhage (including haemoptysis, GI bleeding, pulmonary and CNS haemorrhage, vag bleeding, epistaxis).

Monitoring Parameters

Monitor BP every 2-3 wk. Monitor for development or worsening of proteinuria/nephritic syndrome w/ urine dipstick.

Drug Interactions

May increase risk of microangiopathic haemolytic anaemia w/ sunitinib. May increase risk of agranulocytosis and pancytopenia w/ dipyrone. May increase risk of agranulocytosis w/ clozapine. May increase risk of hand-foot skin reaction w/ sorafenib. May increase risk of osteonecrosis of the jaw w/ bisphosphonate derivatives.

Action

Description:
Mechanism of Action: Bevacizumab is a recombinant humanised monoclonal antibody that binds to vascular endothelial growth factor (VEGF). It prevents interaction of VEGF w/ its receptors (Flt-1, KDR) on the surface of endothelial cells & thereby inhibits the angiogenesis that occurs during tumour growth.
Pharmacokinetics:
Distribution: Volume of distribution: 46 mL/kg.
Excretion: Elimination half-life: Approx 20 days.

Storage

Store between 2-8°C. Do not freeze. Protect from light. Reconstituted soln: Store between 2-8°C, stable up to 8 hr.

MIMS Class

Targeted Cancer Therapy

ATC Classification

L01FG01 - bevacizumab ; Belongs to the class of VEGF/VEGFR (Vascular Endothelial Growth Factor) inhibitors. Used in the treatment of cancer.

References

Anon. Bevacizumab. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/11/2014.

Avastin Injection, Solution (Genentech, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/11/2014.

Avastin Solution for Intravenous Infusion. U.S. FDA. https://www.fda.gov/. Accessed 03/11/2014.

Buckingham R (ed). Bevacizumab. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/11/2014.

Joint Formulary Committee. Bevacizumab. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/11/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Bevacizumab. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 03/11/2014.

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