Daily Medication Pearl: Bevacizumab (Avastin)

Medication Pearl of the Day: Bevacizumab (Avastin)

Indication: Bevacizumab (Avastin) is a vascular endothelial growth factor inhibitor indicated for the treatment of the following cancer types:

• Stage III or IV ovarian cancer after primary surgery
  • Bevacizumab, in combination with carboplatin and paclitaxel, followed by bevacizumab as a single agent, is indicated for the treatment of patients with stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgical resection.
• Recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer
  • Bevacizumab, in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan, is indicated for the treatment of patients with platinum-resistant recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who received no more than 2 prior chemotherapy regimens.
  • Bevacizumab, in combination with carboplatin and paclitaxel, or with carboplatin and gemcitabine, followed by Bevacizumab as a single agent, is indicated for the treatment of patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
• Persistent, recurrent, or metastatic cervical cancer
  • Bevacizumab, in combination with paclitaxel and cisplatin or paclitaxel and topotecan, is indicated for the treatment of patients with persistent, recurrent, or metastatic cervical cancer.
• Metastatic renal cell carcinoma
  • Bevacizumab, in combination with interferon alfa, is indicated for the treatment of metastatic renal cell carcinoma.
• Recurrent glioblastoma
  • Bevacizumab is indicated for the treatment of recurrent glioblastoma in adults.
• First-line non-squamous non-small cell lung cancer
  • Bevacizumab, in combination with carboplatin and paclitaxel, is indicated for the first‑line treatment of patients with unresectable, locally advanced, recurrent or metastatic non–squamous non–small cell lung cancer.
• Metastatic colorectal cancer
  • Bevacizumab, in combination with intravenous fluorouracil-based chemotherapy, is indicated for the first‑ or second‑line treatment of patients with metastatic colorectal cancer.
  • Bevacizumab, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy, is indicated for the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line bevacizumab -containing regimen.
  • Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.
• Hepatocellular carcinoma
  • Bevacizumab, in combination with atezolizumab, is indicated for the treatment of patients with unresectable or metastatic hepatocellular carcinoma who have not received prior systemic therapy.

Insight:

• Dosage forms: Injection 100 mg/4 mL (25 mg/mL) or 400 mg/16 mL (25 mg/mL) in a single-dose vial.
• Adverse events: Most common adverse reactions (incidence > 10%) are epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, hemorrhage, lacrimation disorder, back pain. and exfoliative dermatitis.
• Mechanism of action: Bevacizumab binds VEGF and prevents the interaction of VEGF to its receptors (Flt-1 and KDR) on the surface of endothelial cells. The interaction of VEGF with its receptors leads to endothelial cell proliferation and new blood vessel formation in in vitro models of angiogenesis.
• Manufacturer: Genentech

Sources:

• AVASTIN Prescribing Information (gene.com)
• avastin image - Google Search
• https://www.avastin.com/hcp.html