Drug Action
Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor.
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Individual generic drug information
Extracted information for Bevacizumab only.
Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor.
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Treatment of metastatic colorectal cancer in combination with fluoropyrimidine-based chemotherapy | First-line treatment of metastatic breast cancer in combination with paclitaxel when treatment with other chemotherapy, including taxanes or anthracyclines is not appropriate | First-line treatment of metastatic breast cancer in combination with capecitabine when Immune system and malignant disease treatment with other chemotherapy, including taxanes or anthracyclines is not appropriate (patients who have received adjuvant taxane or anthracycline-containing regimens in the previous 12 months should not be treated with bevacizumab in combination with capecitabine) | Advanced or metastatic renal cell carcinoma in combination with interferon alfa-2a | First- line treatment of unresectable advanced, metastatic or recurrent non-small cell lung cancer other than predominantly squamous cell histology (In combination with platinum-based chemotherapy)| First-line treatment of advanced (FIGO stages IIIB, IIIC and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer (in combination with carboplatin and paclitaxel) | First recurrence of platinum-sensitive epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who have not been treated previously with bevacizumab or other drugs that target vascular endothelial growth factor (in combination with carboplatin and gemcitabine) ▶BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol)
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Elective surgery (withhold treatment and avoid for at least 28 days after major surgery or until wound fully healed). history of arterial thromboembolism. history of cardiovascular disease (increased risk of cardiovascular events, especially in the elderly). history of hypertension (increased risk of proteinuria—discontinue if nephrotic syndrome). increased risk of fistulas (discontinue permanently if tracheo-oesophageal or grade 4 fistula develops). increased risk of haemorrhage. increased risk of tumour-associated haemorrhage. intra-abdominal inflammation (risk of gastro-intestinal perforation and gall bladder perforation. uncontrolled hypertension. untreated CNS metastases
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NICE decisions ▶Bevacizumab and cetuximab for the treatment of metastatic colorectal cancer (January 2007) NICE TA118 Bevacizumab in combination with fluorouracil plus folinic acid, with or without irinotecan, is not recommended for the first-line treatment of metastatic colorectal cancer; see also NICE guidance Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first-line chemotherapy. www.nice.org.uk/guidance/ta118 ▶Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of metastatic colorectal cancer (December 2010) NICE TA212 Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine is not recommended for the treatment of metastatic colorectal cancer. www.nice.org.uk/guidance/ta212 ▶Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first-line chemotherapy (January 2012) NICE TA242 Bevacizumab in combination with non-oxaliplatin (fluoropyrimidine-based) chemotherapy is not recommended for the treatment of patients with metastatic colorectal cancer that has progressed after first- line chemotherapy; see also NICE guidance Bevacizumab and cetuximab for the treatment of metastatic colorectal cancer (January 2007). www.nice.org.uk/guidance/ta242 ▶Bevacizumab (first-line), sorafenib (first and second-line), sunitinib (second-line) and temsirolimus (first-line) for the treatment of advanced and/or metastatic renal cell carcinoma (August 2009) NICE TA178 Bevacizumab, sorafenib, and temsirolimus are not recommended as first-line treatments for people with advanced and/or metastatic renal cell carcinoma. Sorafenib and sunitinib are not recommended as second- line treatments for people with advanced and/or metastatic renal cell carcinoma. www.nice.org.uk/guidance/ta178 ▶Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer (February 2011) NICE TA214 Bevacizumab in combination with a taxane is not recommended for the first-line treatment of metastatic breast cancer. www.nice.org.uk/guidance/ta214 ▶Bevacizumab in combination with capecitabine for the first- line treatment of metastatic breast cancer (August 2012) NICE TA263 Bevacizumab in combinations with capecitabine is not recommended within its marketing authorisation for the first-line treatment of metastatic breast cancer, that is, when treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate, or when taxanes or anthracyclines have been used as part of adjuvant treatment in the previous 12 months. www.nice.org.uk/guidance/ta263 ▶Bevacizumab in combination with paclitaxel and carboplatin for the first-line treatment of advanced ovarian cancer (May 2013) NICE TA284 Bevacizumab in combination with paclitaxel and carboplatin is not recommended for the first-line treatment of advanced ovarian cancer (including fallopian tube and primary peritoneal cancer). www.nice.org.uk/guidance/ta284 ▶Bevacizumab in combination with gemcitabine and carboplatin for the treatment of the first recurrence of platinum-sensitive advanced ovarian cancer (May 2013) NICE TA285 Bevacizumab in combination with gemcitabine and carboplatin is not recommended within its marketing authorisation, that is, for the treatment of the first recurrence of platinum-sensitive advanced ovarian cancer (including fallopian tube and primary peritoneal cancer) that has not been previously treated with bevacizumab or other vascular endothelial growth factor (VEGF) inhibitors or VEGF receptor-targeted agents. www.nice.org.uk/guidance/ta285 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (May 2012) that bevacizumab (Avastin ®) is not recommended for use within NHS Scotland for the first line treatment of patients with metastatic breast cancer in whom treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate. The Scottish Medicines Consortium has advised (September 2015) that bevacizumab (Avastin ®) is accepted for restricted use within NHS Scotland in combination with paclitaxel for the treatment of adult patients with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with bevacizumab or other vascular endothelial growth factor (VEGF) inhibitors or VEGF receptor-targeted agents. The Scottish Medicines Consortium has advised (November 2015) that bevacizumab (Avastin ®) is accepted for restricted use within NHS Scotland in combination with carboplatin and paclitaxel for the first-line treatment of advanced FIGO stage IV epithelial ovarian, fallopian tube, or primary peritoneal cancer. All Wales Medicines Strategy Group (AWMSG) decisions The All Wales Medicines Strategy Group has advised (September 2017) that bevacizumab (Avastin ®) is not recommended for use within NHS Wales in combination with paclitaxel and cisplatin, or alternatively, paclitaxel and topotecan in patients who cannot receive platinum therapy, for the treatment of adults with persistent, recurrent, or metastatic carcinoma of the cervix. The case for cost-effectiveness has not been proven.
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Extracted information for Bevacizumab only.
MHRA/CHM ADVICE: BEVACIZUMAB AND SUNITINIB: RISK OF OSTEONECROSIS OF THE JAW (JANUARY 2011) Treatment with bevacizumab or sunitinib may be a risk factor for the development of osteonecrosis of the jaw. Patients treated with bevacizumab or sunitinib, who have previously received bisphosphonates, or are treated concurrently with bisphosphonates, may be particularly at risk. Dental examination and appropriate preventive dentistry should be considered before treatment with bevacizumab or sunitinib. If possible, invasive dental procedures should be avoided in patients treated with bevacizumab or sunitinib who have previously received, or who are currently receiving, intravenous bisphosphonates.
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→Appendix 1: monoclonal antibodies
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▶Common or very common Abscess. anaemia. appetite decreased. arthralgia. asthenia. congestive heart failure. constipation. cough. decreased leucocytes. dehydration. diarrhoea. drowsiness. dysarthria. dysphonia. dyspnoea. electrolyte imbalance. embolism and thrombosis. eye disorders. fever. fistula. gastrointestinal discomfort. gastrointestinal disorders. haemorrhage. headache. healing impaired. hypersensitivity. hypertension. hypoxia. increased risk of infection. infusion related reaction. mucositis. muscle weakness. myalgia. nausea. neutropenia. ovarian failure. pain. pelvic pain. peripheral neuropathy. proteinuria. rectovaginal fistula. sepsis. skin reactions. stomatitis. stroke. supraventricular tachycardia . syncope. taste altered. thrombocytopenia. vomiting. weight decreased ▶Rare or very rare Encephalopathy. necrotising fasciitis (discontinue and initiate treatment promptly) Immune system and malignant disease ▶Frequency not known Chest pain. chills. flushing. gallbladder perforation. hyperglycaemia. hypotension. nasal septum perforation. osteonecrosis of jaw. pulmonary hypertension. renal thrombotic microangiopathy
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Effective contraception required during and for at least 6 months after treatment in women.
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Avoid—toxicity in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid breast- feeding during and for at least 6 months after treatment.
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▶Monitor for necrotising fasciitis (usually secondary to wound healing complications, gastro-intestinal perforation or fistula formation)—discontinue and initiate treatment promptly. ▶Monitor blood pressure. ▶Monitor for congestive heart failure. ▶Monitor for posterior reversible encephalopathy syndrome (presenting as seizures, headache, altered mental status, visual disturbance or cortical blindness, with or without hypertension). ▶Consider dental check-up before initiating treatment (risk of osteonecrosis of the jaw).
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Extracted information for Bevacizumab only.
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection Solution for infusion ▶Avastin (Roche Products Ltd) Bevacizumab 25 mg per 1 ml Avastin 400mg/16ml solution for infusion vials | 1 vial P £924.40 (Hospital only) Avastin 100mg/4ml solution for infusion vials | 1 vial P £242.66 (Hospital only)
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Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
(consult local protocol)
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 931