Bevacizumab
Generic Name: Bevacizumab
Brand Names: Alymsys (bevacizumab-maly), Avastin (bevacizumab), Mvasi (bevacizumab-awwb), Vegzelma (bevacizumab-adcd), Zirabev (bevacizumab-bvzr)
Ingredients: Bevacizumab
Drug Class: VEGF/VEGFR inhibitors
Controlled Status: Not a Controlled Substance
Availability: Prescription Medication only
What is Bevacizumab?
Bevacizumab injection products belong to the class of medications known as antiangiogenic agents. They function by halting the formation of blood vessels that supply tumors with oxygen and nutrients, thus impeding the growth and spread of these cancers. Bevacizumab injection formulations are employed alongside other chemotherapy medications for the treatment of specific types of cancers. These include colorectal cancer, non-small cell lung cancer, glioblastoma, renal cell cancer, cervical cancer, and ovarian, fallopian tube, or peritoneal cancers. Additionally, Bevacizumab (marketed as Avastin) is utilized in conjunction with atezolizumab (sold as Tecentriq) to address hepatocellular carcinoma (HCC), a form of liver cancer that has either spread or is inoperable, particularly in patients who have not undergone prior chemotherapy.
What is Bevacizumab Used for?
Bevacizumab, marketed under the brand name Avastin and other names, operates by inhibiting a specific protein called vascular endothelial growth factor (VEGF). This action reduces the blood supply to tumors, consequently slowing down their growth. Bevacizumab is a medication employed for the treatment of various cancer types and a specific eye condition. In adults, it is utilized on its own or in conjunction with other cancer therapies to manage particular brain tumors and cancers affecting the kidney, liver, lung, colon, rectum, cervix, ovary, or fallopian tube. In many of these conditions, it is often used as the initial treatment. When addressing age-related macular degeneration, Bevacizumab is administered through an intravitreal injection into the eye. Furthermore, Bevacizumab is applied in adults, either as a standalone treatment or as part of a combination therapy, for cancers that affect the membrane lining the abdominal organs.
How does Bevacizumab Work?
Bevacizumab is a humanized monoclonal antibody created through genetic engineering, designed to impede angiogenesis by blocking vascular endothelial growth factor A (VEGF-A). VEGF-A is a protein that plays a crucial role in promoting the growth of new blood vessels, a process known as angiogenesis, which is often seen in various diseases, notably cancer. Bevacizumab works by binding to VEGF-A, thereby exerting its effects outside of the cells. However, in certain cases, like cervical and breast cancer, it can also be absorbed by cells through a process called constitutive endocytosis. It’s noteworthy that Bevacizumab was the first angiogenesis inhibitor made available in the United States.
Bevacizumab Dosage
Bevacizumab belongs to the drug class known as Vascular Endothelial Growth Factor (VEGF) Inhibitors. The available drug forms are Intravenous Solution available in strengths of 25 mg/mL, provided in single-dose vials of 4 mL and 16 mL. This medication is available by prescription only.
Avastin is used in the treatment of various cancers, including colorectal cancer, non-small cell lung cancer, glioblastoma multiforme, renal cell carcinoma, cervical cancer, ovarian cancer, fallopian tube cancer, peritoneal cancer, and hepatocellular carcinoma. The prescribed Avastin dosage depends on several factors, such as the specific condition being treated, your age, any underlying medical conditions, and whether Avastin is administered alongside traditional chemotherapy drugs. Typically, your healthcare provider will initiate your treatment with a lower dosage and make adjustments as needed to achieve the desired therapeutic effect. The goal is to find the smallest effective dosage tailored to your individual needs.
What are the Side Effects of Bevacizumab?
During the injection, you may also encounter certain side effects. If you feel dizzy, nauseated, light-headed, itchy, sweaty, or experience symptoms like a headache, chest tightness, back pain, difficulty breathing, or facial swelling, promptly inform your healthcare provider.
Bevacizumab has the potential to cause a rare yet serious neurologic disorder affecting the brain. Symptoms may manifest shortly after your initial dose or, in some cases, up to a year after commencing treatment. If you experience extreme weakness or fatigue, headache, confusion, vision problems, fainting, or seizures (blackouts or convulsions), contact your doctor without delay.
Additionally, Bevacizumab may increase your tendency to bleed. Contact your healthcare provider or seek emergency medical assistance if you notice easy bruising, unusual bleeding, or bleeding that doesn’t cease. Indications of bleeding in your digestive tract include severe stomach pain, bloody or tarry stools, or coughing up blood or vomit resembling coffee grounds. Signs of bleeding in the brain encompass sudden numbness or weakness, slurred speech, severe headache, vision or balance issues.
In some cases, individuals taking Bevacizumab have experienced complications like perforations (holes or tears) or fistulas (abnormal passageways) in various organs, such as the stomach, intestines, throat, lungs, gallbladder, kidney, bladder, or vagina. Seek medical attention if you encounter severe stomach pain or if you feel as if you’re choking when eating or drinking.
Additional concerns that warrant contacting your doctor include slow wound healing, skin infections or open sores, missed menstrual periods, kidney problems (swelling, decreased urination, fatigue, or breathlessness), signs of a blood clot (chest pain, sudden cough or breathlessness, dizziness, coughing up blood, pain, swelling, or warmth in one leg), heart problems (chest pain or pressure, pain radiating to your jaw or shoulder, nausea, sweating, swelling, rapid weight gain, shortness of breath), and low white blood cell counts (fever, mouth sores, skin sores, sore throat, or cough). It’s essential to be aware that your cancer treatment may be delayed or permanently discontinued if certain side effects arise.
Some of the more common side effects of Bevacizumab include increased blood pressure, headaches, back pain, dry or watery eyes, dry or flaky skin, a stuffy or runny nose, sneezing, and alterations in your sense of taste.
For more details about Bevacizumab Side Effects
Contact your healthcare provider for guidance regarding any potential side effects. You can also report side effects to the U.S. Food and Drug Administration (FDA) by calling 1-800-FDA-1088.
How to Use Bevacizumab?
Bevacizumab injection products are provided in a liquid form and are administered intravenously at a slow pace. A healthcare professional, typically a doctor or nurse, will administer bevacizumab injection products in a medical office, infusion center, or hospital setting. The frequency of these injections is usually once every 2 to 3 weeks. Your specific dosing schedule will be determined based on your medical condition, the other medications you may be taking, and how your body responds to the treatment.
For the first dose of bevacizumab injection, it is important to allocate 90 minutes. During this initial administration, a doctor or nurse will closely monitor your body’s response to bevacizumab. If there are no serious issues during the first dose, subsequent doses of the medication are typically administered over a period of 30 to 60 minutes each.
What Happens if I Miss a Dose of Bevacizumab?
If you miss an appointment for one of your Avastin doses, it’s essential to contact your doctor’s office promptly. The medical team there can help you reschedule your appointment to make sure you receive your prescribed dose of the medication.
Pros and Cons of Bevacizumab
| Pros | Cons |
| Shorter infusion times (only 30 minutes, after the first two treatments) | Can cause high blood pressure and kidney problems, hence require regular monitoring |
| More precise in the way it targets cancer cells compared to traditional chemotherapy | Requires scheduled visits to the clinic or infusion center to receive your dose |
| Given once every 2 or 3 weeks only | Not at all safe during pregnancy since it can harm an unborn baby |
Interaction between Bevacizumab and other Drugs
- Alendronate
- Anifrolumab
- Chloramphenicol
- Chloramphenicol Ophthalmic
- Clozapine
- Daunorubicin
- Daunorubicin Liposomal
- Deferiprone
- Dimethyl Fumarate
- Diroximel Fumarate
- Doxorubicin
- Doxorubicin Liposomal
- Efgartigimod Alfa
- Eflapegrastim
- Epirubicin
- Erlotinib
- Etidronate
- Filgrastim
- Ibandronate
- Idarubicin
- Idelalisib
- Monomethyl Fumarate
- Palifermin
- Pamidronate
- Panitumumab
- Pegfilgrastim
- Radium 223 Dichloride
- Risedronate
- Romosozumab
- Ropeginterferon Alfa-2b
- Rozanolixizumab
- Samarium Sm 153 Lexidronam
- Sargramostim
- Sodium Phosphate P32
- Strontium-89 Chloride
- Sunitinib
- Tbo-Filgrastim
- Thalidomide
- Tiludronate
- Topotecan
- Valrubicin
- Zoledronic Acid
Bevacizumab disease interactions
There are 7 disease interactions with bevacizumab which include:
- fistula formation
- GI perforation
- bleeding
- hypertension
- PRES
- proteinuria
- thromboembolic disorders
What are the Risks and Warnings for Bevacizumab?
Bevacizumab and Allergy Warning
Inform your doctor if you’ve ever experienced an unusual or allergic response to this medication or any other drugs. It’s also crucial to let your healthcare provider know if you have allergies to other substances such as certain foods, dyes, preservatives, or animal-related allergens. When using over-the-counter products, be sure to carefully review the label or package ingredients.
It’s crucial to be aware that bevacizumab injection products can potentially lead to severe reactions during the infusion process. If you encounter any of the following symptoms, it’s important to promptly inform your doctor: difficulty breathing or shortness of breath, chills, trembling, sweating, headaches, chest pain, dizziness, feeling lightheaded, flushing, itching, rash, or hives. Depending on your reaction or any other side effects you may experience, your doctor might need to adjust the infusion rate, or in some cases, delay or discontinue your treatment.
Bevacizumab and Alcohol Warning
The safety of consuming alcohol during Avastin treatment is currently not known, and there is no established guideline regarding the amount of alcohol that can be safely consumed while using Avastin. While there have been no reported interactions between Avastin and alcohol, it’s important to note that alcohol can interact with certain chemotherapy drugs that may be administered alongside Avastin.
If you consume alcohol, it is strongly recommended to have a discussion with your doctor about whether it is safe for you to continue drinking while undergoing Avastin treatment. Your healthcare provider can provide you with personalized guidance and advice based on your specific medical situation.
Bevacizumab and Birth Control Needs
Using Avastin during pregnancy can potentially harm fetuses. If you’re sexually active and capable of becoming pregnant, it’s essential to discuss your birth control requirements with your doctor while you’re undergoing Avastin treatment.
For Individuals Assigned Female at Birth Using Avastin
Females taking Avastin who are of reproductive age should utilize effective contraception throughout their treatment. Additionally, it’s advisable to continue using contraception for at least 6 months after the final Avastin dose.
For Individuals Assigned Male at Birth Using Avastin
The manufacturer of Avastin has not provided specific birth control recommendations for males using this medication. If you’re a male undergoing Avastin treatment and are sexually active with individuals capable of becoming pregnant, it’s advisable to consult your healthcare provider regarding your birth control needs when using this drug.
Warning with People with Certain Health Conditions
- Angina (severe chest pain)
- Bleeding problems
- Blood clots
- Diabetes
- Esophagus problems
- Heart attack
- Heart failure
- Hypertension (high blood pressure)
- Kidney problems
- Liver problems
- Protein in the urine
- Stomach or bowel problems (eg, blockage, fistula, perforation)
- Stroke
- Wound healing problems—Use with caution. May make these conditions worse
- Hemoptysis (coughing up blood), recent history of—Should not be used in patients with this condition.
- Surgery, recent—Use with caution. May cause side effects to become worse.
There are 7 disease interactions with bevacizumab which include:
- Fistula Formation
- GI Perforation
- Bleeding
- Hypertension
- Pres
- Proteinuria
- Thromboembolic Disorders
Warning with other Groups
Bevacizumab and Breastfeeding
There is a lack of sufficient studies in women to assess the risk to nursing infants when using this medication during breastfeeding. It is essential to weigh the potential benefits against the possible risks before using this medication while breastfeeding.
Bevacizumab and Pregnancy
Avastin may pose risks to developing fetuses when used during pregnancy. Clinical trials involving pregnant women to thoroughly assess the impact of Avastin are limited. However, the drug’s manufacturer has received post-marketing reports, which provide information about drug effects after its release to the market. Some of these reports have highlighted concerns regarding fetal problems associated with Avastin use during pregnancy.
If you are pregnant, it is crucial to have a discussion with your doctor before considering Avastin treatment. Your healthcare provider will thoroughly review the potential risks and benefits of using Avastin during pregnancy and may suggest alternative cancer treatments as a safer option.
Pediatric
Studies examining the impact of age on the effects of bevacizumab injection in the pediatric population have not been conducted. Therefore, the safety and effectiveness of this medication in children have not been established.
Geriatric
While studies conducted so far have not revealed any age-specific issues that would restrict the utility of bevacizumab injection in elderly individuals, it’s important to note that older patients are more likely to have age-related heart or blood vessel conditions. This may necessitate caution when administering bevacizumab injection to elderly patients.
Expiration, Storage and Disposal
The packaging of Avastin (Bevacizumab) should clearly display its expiration date. It is of utmost importance not to use this medication beyond the specified expiration date, as its effectiveness may decrease over time.
Bevacizumab vials must be stored in a refrigerator within a temperature range of 36°F to 46°F (2°C to 8°C). It’s essential to be aware that Bevacizumab’s stability can be compromised if it is exposed to room temperature. Therefore, it is crucial to avoid storing it outside of the recommended temperature range.
Regarding disposal, it is advisable to follow the instructions provided by your healthcare provider or pharmacist. Typically, medications like Avastin should be appropriately disposed of by taking them to a designated medication disposal site or adhering to any specific disposal guidelines outlined in the medication’s packaging.
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What are the Alternatives of Bevacizumab?
| Cancer Type | Chemotherapy Drugs | Immunotherapy Drugs | Targeted Therapies, |
| Glioblastoma | Temozolomide (Temodar)VincristineCarmustine (Bicnu) | Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev)Bevacizumab-Maly (Alymsys)Bevacizumab-Awwb (Mvasi) | – |
| Ovarian Cancer | CisplatinEtoposidePaclitaxel (Abraxane)VincristineBleomycinCarboplatinCyclophosphamide (Cytoxan) | Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev)Bevacizumab-Maly (Alymsys)Bevacizumab-Awwb (Mvasi) | Olaparib (Lynparza)Rucaparib (Rubraca)Niraparib (Zejula) |
| Colon Cancer | Oxaliplatin (Eloxatin)Capecitabine (Xeloda)FluorouracilIrinotecan (Camptosar, Onivyde) | Bevacizumab-Maly (Alymsys)Pembrolizumab (Keytruda)Bevacizumab-Awwb (Mvasi)Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev) | Regorafenib (Stivarga)Ziv-Aflibercept (Zaltrap)Cetuximab (Erbitux)Panitumumab (Vectibix)Ramucirumab (Cyramza) |
| Lung Cancer | Doxorubicin (Doxil)GemcitabinePaclitaxelCarboplatinDocetaxelLiposomal | Bevacizumab-Awwb (Mvasi)Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev)Nivolumab (Opdivo)Pembrolizumab (Keytruda)Bevacizumab-Maly (Alymsys) | Cetuximab (Erbitux)Erlotinib (Tarceva)Necitumumab (Portrazza)Ramucirumab (Cyramza)Afatinib (Gilotrif)Alectinib (Alecensa)Brigatinib (Alunbrig) |
| Cervical Cancer | BleomycinTopotecan (Hycamtin) | Pembrolizumab (Keytruda)Bevacizumab-Maly (Alymsys)Bevacizumab-Awwb (Mvasi)Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev) | – |
| Kidney Cancer | Cisplatin5-FluorouracilGemcitabine | Pembrolizumab (Keytruda)Bevacizumab-Maly (Alymsys)Bevacizumab-Awwb (Mvasi)Bevacizumab-Adcd (Vegzelma)Bevacizumab-Bvzr (Zirabev)Ipilimumab (Yervoy)Nivolumab (Opdivo) | Sorafenib (Nexavar)Sunitinib (Sutent)Axitinib (Inlyta)Everolimus (Afinitor) |
| Liver Cancer | – | Ipilimumab (Yervoy)Nivolumab (Opdivo)Pembrolizumab (Keytruda) | Regorafenib (Stivarga)Sorafenib (Nexavar)Cabozantinib (Cabometyx)Lenvatinib (Lenvima)Ramucirumab (Cyramza) |
FAQs
Bevacizumab AWWB belongs to the drug class known as antiangiogenic agents. These drugs function by inhibiting the formation of blood vessels that supply oxygen and nutrients to tumors, thereby slowing down the growth and spread of tumors.
Bevacizumab BVZR is utilized for the treatment of nonsquamous, non-small cell lung cancer (NSCLC) that has metastasized, recurred, or is inoperable. It is also employed in the management of recurrent glioblastoma, a specific type of brain tumor.
Bevacizumab use in ophthalmology is off-label, meaning it is not FDA approved for ocular use. In the USA more than 20% of the used drugs are off-label. It is most commonly used to treat CNV (in AMD and other diseases), diabetic macular edema (DME), and macular edema due to retinal vein occlusions.
Immunotherapy using monoclonal antibodies like atezolizumab can enhance the immune system’s ability to target cancer cells and impede the growth and spread of tumors. Similarly, bevacizumab, another monoclonal antibody, can also hinder the growth and spread of cancer cells.
Bevacizumab helps relieve symptoms of brain edema resulting from radiation-induced brain necrosis by inhibiting VEGF and affecting the vascular tissue surrounding the area of brain necrosis.
Yes, bevacizumab is approved by the FDA. The FDA has approved trifluridine and tipiracil in combination with bevacizumab for previously treated metastatic colorectal cancer.
Combination 1st-line treatment with IRINOTECAN-based chemotherapy and bevacizumab showed improved overall survival (OS) in cases with KRAS wild-type tumors (HR = 0.69; p = 0.048) and KRAS codon 12 or codon 13 mutated tumors (HR = 0.68, p = 0.07).
Laboratory studies comparing Alymsys with Avastin have demonstrated that the active substance in Alymsys closely resembles the one found in Avastin concerning its structure, purity, and biological activity. Research has also indicated that administering Alymsys results in similar levels of the active substance in the body as giving Avastin.
Bevacizumab is added to Folfox because the combination of Bevacizumab and the Folfox-4 regimen is used as the initial treatment for patients with metastatic colorectal cancer (mCRC). Hyperthermia is also regarded as a useful complementary therapy for cancer treatment due to its various anti-tumor mechanisms, some of which align with Bevacizumab’s role in inhibiting angiogenesis.
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