Bevacizumab

DEA Class; Rx

Common Brand Names; Avastin, Mvasi, bevacizumab-awwb, Zirabev, bevacizumab-bvzr, Alymsys, bevacizumab-maly, bevacizumab-adcd, Vegzelma

• Antineoplastics, Monoclonal Antibody; 
• Antineoplastics, VEGF Inhibitor

Indicated for Metastatic Colorectal Cancer

Avastin, Mvasi, Zirabev, Alymsys,Vegzelma

In combination with fluorouracil-based chemotherapy

• First-line or second-line treatment for metastatic colorectal carcinoma (mCRC) in combination with fluorouracil (5-FU)-based chemotherapy

In combination with a fluoropyrimidine plus irinotecan or oxaliplatin-based chemotherapy

• Second-line treatment of patients with mCRC who have progressed on a first-line bevacizumab-containing regimen
• Use in combination with a fluoropyrimidine (eg, 5-FU, capecitabine) plus irinotecan or oxaliplatin-based chemotherapy

Indicated for unresectable, locally advanced, recurrent or metastatic, nonsquamous non-small cell lung cancer (NSCLC) in combination with carboplatin and paclitaxel

Indicated for metastatic renal cell carcinoma in combination with interferon alfa-2a

Indicated, in combination with paclitaxel plus cisplatin or topotecan, for persistent, recurrent, or metastatic cervical cancer

Also for Ovarian, Fallopian Tube, or Peritoneal Cancer

Platinum-resistant

• Indicated in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for adults with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than 2 prior chemotherapy regimens

Platinum-sensitive

• Indicated for women with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer either in combination with carboplatin and paclitaxel or in combination with carboplatin and gemcitabine chemotherapy, followed by bevacizumab alone

Treatment of stage III or IV disease following initial surgical resection

• Indicated in combination with carboplatin and paclitaxel, followed by bevacizumab as a single agent, for patients with stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgical resection

Indicated for treatment of recurrent glioblastoma

Indication for metastatic breast cancer (HER2-negative) revoked by FDA in November 2011 due to failure to delay tumor growth or provide survival benefit

Off-label indication for exudative age-related macular degeneration

Indicated, in combination with atezolizumab, for unresectable or metastatic hepatocellular carcinoma (HCC) in patients who have not received prior systemic therapy

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Epithelial ovarian, fallopian tube or primary peritoneal cancer)

Treatment following resection

• Fatigue (72-80%)

• Nausea (53-58%)

• Arthralgia (33-41%)

• Diarrhea (38-40%)

• Headache (26-34%)

• Hypertension (24-32%)

• Epistaxis (30-31%)

• Dyspnea (26-28%)

• Stomatitis (19-25%)

• Pain in extremity (19-25%)

• Muscular weakness (13-15%)

• Dysarthria (10-12%)

Platinum-resistant

• Neutropenia, Grade 2-4 (31%)

• Hypertension, Grade 2-4 (19%)

• Peripheral sensory neuropathy, Grade 2-4 (18%)

• Mucosal inflammation, Grade 2-4 (13%)

• Proteinuria, Grade 2-4 (12%)

• Infection, Grade 2-4 (11%)

• Palmar-plantar erythrodysesthesia, Grade 2-4 (11%)

Platinum-sensitive

• Fatigue (82%)

• Nausea (72%)

• Thrombocytopenia (58%)

• Epistaxis (55%)

• Headache (49%)

• Hypertension (42%)

• Diarrhea (38-39%)

• Decreased appetite (35%)

• Abdominal pain, stomatitis, vomiting (33%)

• Hyperglycemia (31%)

• Dyspnea (30%)

• Arthralgia (28%)

• Hypomagnesemia (27%)

• Cough (26%)

• Insomnia, back pain (21%)

Bevacizumab products can result in minor hemorrhage, most commonly Grade 1 epistaxis; and serious, and in some cases fatal, hemorrhagic events

Serious, sometimes fatal, arterial thromboembolic events (ATE) including cerebral infarction, transient ischemic attacks, myocardial infarction, angina, and a variety of other ATE; discontinue bevacizumab for severe ATE

Increased risk of venous thromboembolic events (VTE) reported in patients treated with bevacizumab for cervical cancer; discontinue bevacizumab for life-threatening VTE

Monitor blood pressure and treat hypertension; increased risk for severe hypertension; temporarily suspend treatment; discontinue if hypertensive crisis or hypertensive encephalopathy

Increased relative risk for heart failure has been associated with therapy

Posterior reversible encephalopathy syndrome (PRES) reported (0.5%); discontinue if PRES develops

Proteinuria reported; temporarily suspend treatment for ≥2 g proteinuria/24 hr; discontinue if nephrotic syndrome occurs (incidence <1%)

Evaluation for presence of varices recommended within 6 months of initiation of HCC therapy; there is lack of clinical data to support safety in patients with variceal bleeding within 6 months prior to treatment, untreated or incompletely treated varices with bleeding, or high risk of bleeding because these patients were excluded from clinical trials in HCC

Based on findings from animal studies and its mechanism of action, drug may cause fetal harm in pregnant women

No data available on the presence of bevacizumab in human milk, the effects on the breast fed infant, or the effects on milk production

Bevacizumab

injectable solution

• 25mg/mL (4-mL, 16-mL single-dose vials)

Biosimilar to Avastin

• Mvasi (bevacizumab-awwb)
• Zirabev (bevacizumab-bvzr)
• Alymsys (bevacizumab-maly)