Bevacizumab

Table of contents

  • Brand Names
  • Drug Combinations
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Unlabeled Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Caution and personalized dose adjustment in patients with the following genotypes
  • Other genes that may be involved
  • Drug Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names

Europe

Austria: Avastin; Belgium: Avastin; Bulgaria: Avastin; Cyprus: Avastin; Czech Republic: Avastin; Denmark: Avastin; Estonia: Avastin; Finland: Avastin; France: Avastin; Germany: Avastin; Greece: Avastin; Hungary: Avastin; Ireland: Avastin; Italy: Avastin; Latvia: Avastin; Lithuania: Avastin; Luxembourg: Avastin; Malta: Avastin; Netherlands: Avastin; Poland: Avastin; Portugal: Avastin; Romania: Avastin; Slovakia: Avastin; Slovenia: Avastin; Spain: Avastín; Sweden: Avastin; UK: Avastin.

North America

Canada: Avastin; USA: Avastin.

Latin America

Argentina: Avastín; Brazil: Avastín; Mexico: Avastín.

Asia

Japan: Avastin.

Drug combinations

Bevacizumab and Docetaxel

Bevacizumab, Fluorouracil and Leucovorin

Bevacizumab, Fluorouracil, Irinotecan, and Leucovorin

Bevacizumab, Fluorouracil, Leucovorin, and Oxaliplatin

Chemistry

Bevacizumab: C~6638~H~10160~N~1720~O~2108~S~44~. Immunoglobulin G~1~ (human-mouse monoclonal rhuMAb-VEGF γ-chain anti-human vascular endothelial growth factor), disulfide with human-mouse monoclonal rhuMAb-VEGF light chain, dimer. CAS-216974-75-3.

Pharmacologic Category

Other Antineoplastic Agents; Monoclonal Antibodies. Vascular Endothelial Growth Factor Inhibitor; Monoclonal Antibody. (ATC-Code: L01XC07).

Mechanism of action

Recombinant, humanized monoclonal IgG~1~ antibody containing human framework regions and murine complementarity-determining regions which binds to, and neutralizes, vascular endothelial growth factor (VEGF), preventing its association with endothelial receptors, Flt-1 and KDR. VEGF binding initiates angiogenesis. The inhibition of microvascular growth is believed to retard the growth of all tissues (including metastatic tissue).

Therapeutic use

Treatment of metastatic colorectal cancer, nonsquamous, non-small cell lung cancer, breast cancer (metastatic, HER-2 negative).

Pregnancy and lactiation implications

Bevacizumab is likely to have adverse consequences for fetal development. Not known whether bevacizumab is distributed into milk. Human immunoglobulin G~1~ (IgG~1~) is distributed into milk (the potential for absorption and harm to the infant is unknown).

Unlabeled use

Treatment of breast cancer, malignant mesothelioma, prostate cancer, ovarian cancer (early stage), renal cell cancer, relapsed or refractory solid tumors (brain tumor, neuroblastoma, Ewing’s sarcoma), head and neck cancer, age-related macular degeneration.

Contraindications

Hypersensitivity to bevacizumab, murine proteins, or any component. Do not initiate therapy within 28 days of major surgery, within 7 days of a procedure, or with concurrent COX-2 inhibitor use.

Warnings and precautions

Severe, sometimes fatal, hemorrhagic events may occur. Avoid use in recent hemoptysis (>2.5 mL blood). Serious, sometimes fatal, arterial thromboembolic events reported (increased risk in patients ≥65 years of age and in patients receiving bevacizumab for metastatic colorectal cancer). Severe neutropenia, febrile neutropenia, and serious infection (including pneumonia, catheter infections, and wound infections), sometimes fatal, reported. Gastrointestinal perforation, fistula (including gastrointestinal, enterocutaneous, esophageal, duodenal, and rectal fistulas), and intra-abdominal abscess reported in colorectal cancer or non-small cell lung cancer. Non-gastrointestinal fistula formation (tracheo-esophageal, bronchopleural, biliary, vagina, and bladder), sometimes fatal, reported. May cause and/or worsen hypertension significantly (use caution in pre-existing hypertension). Cases of reversible posterior leukoencephalopathy syndrome reported. Infusion reactions (hypertension, hypertensive crisis, wheezing, hypersensitivity, chest pain, headache, diaphoresis) may occur with the first infusion (uncommon). Proteinuria and/or nephrotic syndrome associated with use (increased risk of proteinuria in patients ≥65 years of age receiving bevacizumab in combination with paclitaxel-carboplatin). Wound dehiscence/wound healing complications reported. Caution in cardiovascular disease. Avoid use in CNS metastases. May potentiate cardiotoxic effects of anthracyclines. When used in combination with myelosuppressive chemotherapy, increased rates of severe or febrile neutropenia and neutropenic infection reported. Potential for immunogenicity.

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