Names and pronunciation
(beh-va-kiz′you-mab) Avastin; MVASi (biosimilar) , Zirabev (biosimilar)
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Drug reference
(beh-va-kiz′you-mab) Avastin; MVASi (biosimilar) , Zirabev (biosimilar)
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Func. class.: Antineoplastic— miscellaneous
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Chem. class.: Monoclonal antibody
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Do not confuse: Avastin/Astelin
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ACTION: Monoclonal antibody selec- tively binds to and inhibits activity of human vascular endothelial growth fac- tor (VEGF) to reduce microvascular growth and metastatic disease progres- B sion
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USES: Non–small-cell lung cancer (NSCLC), metastatic carcinoma of the colon or rectum, renal cell carcinoma, glioblastoma
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Unlabeled uses: Adjunctive for ovarian cancer, (wet) macular degeneration, unresectable malignant pleural mesothe- lioma, diabetic macular edema
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CONTRAINDICATIONS: Hyper- sensitivity, serious bleeding, hypertensive crisis, recent surgery Precautions: Pregnancy, breastfeeding, children, geriatric patients, HF, blood dyscrasias, CV disease, hypertension, surgery, thromboembolic disease, ham- ster protein/murine hypersensitivity
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Black Box Warning: GI perforation, wound dehiscence, bleeding Black Box Warning: Wound dehis- cence: discontinue 28 days prior to elec- tive surgery, do not give for ≥28 days after surgery; make sure wound is healed before giving product • Give as IV infusion over 90 min for first dose and 60 min thereafter if well toler- ated; subsequent infusion may be given over 30 min; do not admix with dextrose • Store refrigerated up to 8 hr (diluted) Black Box Warning: Wound dehis- cence: hold for ≥28 days until incision is healed, discontinue 28 days prior to elec- tive surgery; if wound dehicence occurs discontinue Black Box Warning: GI perforation (constipation, fever, abdominal pain, nausea, vomiting), serious bleeding (bleeding from any orifice, stroke, deep vein thrombosis), nephrotic syndrome, hypertensive crisis; product should be discontinued permanently; surgery should be postponed • Thromboembolic events: monitor for stroke, TIA, MI; usually occurs in geriatric patients who used this product previously • Fistulas: may occur within 6 mo of beginning treatment, may be fatal • Reversible posterior leukoencepha- lopathy syndrome (RPLS): discontinue if this disorder develops (headache, vision B changes, seizures, altered mental status); MRI may be ordered, occurs 16 hr-1 yr after beginning treatment • Pregnancy/breastfeeding: drug may lead to fetal harm; do not use in preg- nancy, do not breastfeed during and for 6 mo after last dose; use contraception during and for 6 mo after last dose Black Box Warning: Hemorrhage/ bleeding: to report bleeding, changes in urinary patterns, edema, abdominal pain • To avoid live virus vaccines • About the need to discontinue product 1 mo before surgery and not to restart until wound is healed • Pregnancy/breastfeeding: that fetal harm may occur, not to breastfeed, not to become pregnant while taking this prod- uct or for 6 mo after discontinuing treat- ment; discuss possible infertility with patient
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SIDE EFFECTS CNS: Asthenia, dizziness, abnormal gait, syncope, headache, confusion CV: Deep vein thrombosis, arterial throm- bosis, hypo/hypertension, heart failure GI: Nausea, vomiting, anorexia, diar- rhea, constipation, abdominal pain, colitis, taste change, dyspepsia, stomati- tis, GI hemorrhage/perforation GU: Proteinuria, vaginal hemorrhage HEMA: Leukopenia, neutropenia, thrombocytopenia META: Bilirubinemia, hypokalemia MISC: Exfoliative dermatitis, alopecia RESP: Dyspnea, upper respiratory tract infection, hemoptysis INTEG: Skin discoloration, infusion reac- tions, dry skin, skin ulcer, palmar-plantar erythrodysesthesia
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INTERACTIONS • Avoid concurrent use with SUNItinib; microangiopathic hemolytic anemia may occur Increase: CV toxicity antineoplastics Increase: osteonecrosis of the jaw—biophosphates Decrease: immune response to live virus vaccines Drug/Lab Increase: bilirubin Decrease: neutrophil, platelets, WBC, potassium
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DOSAGE AND ROUTES Non–small-cell lung cancer • Adult: IV 15 mg/kg over 60-90 min with CARBOplatin and PACLitaxel q3wk Platinum-resistant recurrent epi- thelial ovarian, fallopian tube, or primary peritoneal cancer (Avastin only) • Adult: IV 10 mg/kg q2wk with PACLitaxel and pegylated liposomal DOXOrubicin or topotecan weekly; or 15 mg/kg q3wk with topotecan Platinum-sensitive recurrent epi- thelial ovarian, fallopian tube, or primary peritoneal cancer (Avastin only) • Adult: IV 15 mg/kg q3wk with CARBO platin and PACLitaxel for ≤6 cycles 8 cy- cles, then continue bevacizumab (single agent): 15 mg/kg q3wk until progression Stage III/IV epithelial ovarian, fallo- pian tube, or primary peritoneal cancer after resection (Avastin only) • Adult: IV 15 mg/kg q3wk with CARBOplatin and PACLitaxel for ≤6 cy- cles, then 15 mg/kg q3wk (single agent) for 22 cycles Metastatic colorectal cancer with fluoropyrimidine-irinotecan–based or fluoropyrimidine-oxaliplatin– based or fluoropyrimidine-oxalipla- tin–based treatment for second- line after progression • Adult: IV 5 mg/kg q2wk or 7.5 mg/kg q3wk Persistent, recurrent, or metastatic cervical cancer with PACLitaxel and CISplatin or PACL itaxel and topotecan • Adult: IV infusion 15 mg/kg q3wk First- or second-line treatment of metastatic colon or rectal cancer with 5-FU • Adult: IV infusion 5 mg/kg q14days if used with bolus irinotecan, 5-FU, and leucovorin; or 10 mg/kg q14days if used with oxaliplatin, F-FU, and leucovorin (FOLOX 4); rates vary With CARBOplatin and PACLitaxel as first-line in treatment of unresect- able, recurrent, locally advanced, or metastatic nonsquamous NSCLC • Adult: IV infusion 15 mg q3wk Unresectable or metastatic hepa- tocellular cancer (HCC) in patients who have not received prior sys- temic therapy, with atezolizumab • Adult: IV 15 mg/kg on day 1, q3wk give with atezolizumab (840 mg IV q2wk or 1200 mg IV q3wk or 1680 mg IV q4wk) until disease progression or unac- ceptable toxicity Unresectable malignant pleural mesothelioma (unlabeled) • Adult: IV 15mg/kg q3wk with CISplatin and pemetrexed for up to 6 cy- cles, then bevacizumab 15 mg/kg q3wk maintenance until disease progression or toxicity Diabetic macular edema (unlabeled) • Adult: Intravitreal 1.25 mg (0.05 mL), repeat q4wk depending on re- sponse Neovascular (wet) age-related macular degeneration (AMD) (unlabeled) • Adult/geriatric patients: INTRAVIT- REAL INJECTION 1.25 mg (0.05 mL) monthly into affected eye × 3 mo
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Available forms: Solution for injection 25 mg/mL
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Administer: Intermittent IV INFUSION route • Do not give by IV bolus, IV push; do not shake vial, do not admix, do not freeze • Withdraw amount of product to be given, dilute in 100 mL 0.9% NaCl, dis- card any unused portion
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Assess: • B/P; take frequently if hypertension develops, discontinue if hypertensive cri- sis occurs • For symptoms of infection; may be masked by product • CNS reaction: dizziness, confusion • HF: crackles, jugular venous disten- tion, dyspnea during treatment • GU status (proteinuria): nephrotic syndrome may occur; monitor urinaly- sis for increasing protein level; product should be held if protein ≥2 g/24 hr; re- sume when <2 g/24 hr
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Evaluate: • Therapeutic response: decrease in size of tumors
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid hazardous tasks because con- fusion, dizziness may occur • To report signs of infection: sore throat, fever, diarrhea, vomiting
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PHARMACOKINETICS Half-life 20 days, steady-state 100 days
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• Adult/geriatric patients: INTRAVIT- REAL INJECTION 1.25 mg (0.05 mL) monthly into affected eye × 3 mo
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