Bevacizumab Side Effects

Bevacizumab, a medication that has played a crucial role in cancer treatment. In this blog, we’ll comprehensively explore its side effects, shedding light on common and rare occurrences, serious effects, and the management of allergic reactions. 

We’ll also delve into the less-discussed aspects, such as symptoms of overdose and potential long-term effects. For a holistic understanding, we’ll address how Bevacizumab impacts special age groups, including pregnant women, breastfeeding mothers, the pediatric population, and the elderly. 

Furthermore, we’ll categorize its side effects based on various body systems, enabling you to make informed decisions about this medication’s use. Your health and well-being are paramount, and my mission is to equip you with the knowledge you need to navigate the world of pharmaceuticals.

Common Side Effects

While Bevacizumab has demonstrated its efficacy in the battle against cancer, it’s equally important to be aware of the common side effects to ensure a balanced perspective on its benefits and risks.

• Nosebleed, 
• Rectal bleeding, 
• Increased blood pressure, 
• Headache, 
• Back pain, 
• Dry or watery eyes, 
• Dry or flaky skin, 
• Runny nose, 
• Sneezing, and
• Changes in your sense of tas

Serious Side Effects

More Common

Less Common

• Bone pain
• Difficulty with swallowing
• Fainting
• Severe constipation
• Severe vomiting
• Stomach pain or tenderness

Allergic Reactions

If you experience any signs of an allergic reaction to Bevacizumab, such as hives, difficulty breathing, or swelling of your face, lips, tongue, or throat, it’s imperative to seek immediate medical assistance.

Rare Side Effects

• Back pain
• Blisters
• Blurred vision
• Confusion
• Dizziness
• Drowsiness
• Headache
• Increased thirst
• Loss of consciousness
• Muscle pain or cramps
• Open sores
• Pale skin

Incidence not known

• Bloody mucus or unexplained nosebleeds
• Constipation
• Diarrhea
• Heartburn
• Heavy jaw feeling
• High fever
• Hoarseness
• Indigestion
• Loosening of a tooth
• Nausea
• Pain, swelling, or numbness in the mouth or jaw
• Severe stomach pain
• Stomach cramping or burning
• Stomach pain, usually after eating a meal
• Sudden weakness in the arms or legs
• Sudden, severe chest pain
• Unexplained bleeding or bruising
• Unusual tiredness or weakness
• Voice changes

Other Side Effects

• Belching
• Change in taste or bad unusual or unpleasant (after) taste
• Change in walking and balance
• Clumsiness or unsteadiness
• Dry mouth
• Excess flow of tears
• Hair loss or thinning of hair
• Stomach discomfort or upset
• Weight loss

Categorize the Side Effects of Bevacizumab Based on Various Body Systems

Gastrointestinal

• The occurrence of gastrointestinal perforation, which includes gastrointestinal perforation, fistula formation, and intra abdominal abscess, was reported in patients with colorectal cancer at a rate of 2.4%. In contrast, patients with non-small cell lung cancer (NSCLC) who were receiving bevacizumab experienced gastrointestinal perforation at a rate of 0.9%.
• Intestinal obstruction, intestinal necrosis, mesenteric venous occlusion, ileus, anastomotic ulceration, gastrointestinal perforation and wound dehiscence (complicated by intra-abdominal abscesses), tracheoesophageal fistula.
• Abdominal pain (up to 61%), vomiting (up to 52%), anorexia (up to 43%), constipation (up to 40%), diarrhea (up to 34%), stomatitis (up to 32%), dyspepsia (up to 24%), gastrointestinal hemorrhage (up to 24%), flatulence (up to 19%)
• Dry mouth, colitis, constipation, nausea (1% to 10%)
• TE fistula, upper aerodigestive tract hemorrhage (less than 0.01%)

Cardiovascular

• Hypertension (up to 34%), hypotension (up to 15%)
• Deep vein thrombosis, congestive heart failure (1% to 10%)
• Arterial thromboembolic events (including cerebrovascular accident (stroke), myocardial infarction, transient ischemic attack, angina), fatal arterial thrombotic events, cerebral ischemia, supraventricular tachycardia, both serious and non-serious hemorrhagic events

Nervous system

• Dizziness (up to 26%), sensory neuropathy (24%)
• Confusion, abnormal gait, CNS hemorrhage, cerebrovascular ischemia (1% to 10%)
• Brain-capillary leak syndrome (reversible posterior hyponatremia (less than 0.1%)
• Hypertensive encephalopathy
• Dysgeusia

Hematologic

• Leukopenia (37%), neutropenia (21%)
• Thrombocytopenia (1% to 10%)
• Hemorrhagic events, pancytopenia, febrile neutropenia, decreased hemoglobin, anemia, prothrombin time prolongations, infection with severe neutropenia

Hepatic

• Gallbladder perforation

Metabolic

• Hyperglycemia (up to 26%), hypomagnesemia (up to 24%), hyponatremia (up to 19%), hypoalbuminemia (16%), weight loss (up to 16%), hypokalemia (up to 16%)
• Bilirubinemia (1% to 10%)
• Increased blood potassium, decreased blood phosphorus, increased blood alkaline phosphatase

Musculoskeletal

• Myalgia (up to 15%)
• Bone pain, back pain (1% to 10%)
• Osteonecrosis of the jaw

Genitourinary

• Ureteral stricture

Respiratory

• Upper respiratory infection (up to 47%), severe or fatal hemoptysis (up to 31%), epistaxis (up to 35%), dyspnea (up to 26%)
• Pulmonary hypertension, fatal pulmonary hemorrhage, nasal septum perforation
• Voice alteration (1% to 10%)
• Patients with recent hemoptysis (greater than or equal to 1/2 tsp of red blood) should not receive bevacizumab.

Renal

• Proteinuria (up to 36%)
• Nephrotic syndrome (0.1% to 1%)

Ocular

• Lacrimation increased (10% or more)
• Reactions including infectious endophthalmitis, intraocular inflammation such as sterile endophthalmitis, uveitis and vitritis, retinal detachment, retinal pigment epithelial tear, intraocular pressure increased, intraocular hemorrhage (such as vitreous hemorrhage or retinal hemorrhage and conjunctival hemorrhage). Some of these reactions have resulted in various degrees of visual loss, including permanent blindness.

Dermatologic

• Alopecia (up to 32%)
• Rash/desquamation, skin ulcer (1% to 10%)
• Exfoliative dermatitis, skin discoloration
• Necrotizing fasciitis

Other

• Asthenia (up to 74%), pain (up to 62%), fatigue (up to 80%), headache (up to 37%), peripheral edema (up to 22%), taste disorder (up to 9%)
• Infection with an unknown ANC (1% to 10%)
• Non Gastrointestinal fistula formation, infection without neutropenia (0.1% to 1%)
• Mesenteric venous occlusion, syncope, dehydration, somnolence, polyserositis, polyserositis

Immunologic

• Sepsis, wound healing complications, urinary tract infection, positive assays for treatment-emergent anti-bevacizumab

Long Term Effects of Bevacizumab

While infrequent in clinical studies, Avastin can, on occasion, lead to the development of blood clots within blood vessels. These blood clots have the potential to give rise to significant issues, including conditions like heart attacks (occurring when a clot obstructs blood flow to the heart muscle) and strokes (arising when a clot obstructs blood flow to the brain). Although such occurrences are rare, it’s essential to be aware of the possible long-term side effects associated with Avastin and to promptly discuss any concerns with your healthcare provider.

Side Effects of Bevacizumab During Pregnancy and Breastfeeding

If you have the potential to become pregnant, it’s essential to use effective birth control methods while you are undergoing treatment with Avastin. This precaution should continue for a period of 6 months after your last Avastin dose. Furthermore, it’s important to be aware that Avastin could impact your ability to conceive in the future. If you have plans to become pregnant down the road, it’s advisable to consult with your doctor before commencing Avastin treatment.

The safety of using Avastin during breastfeeding is not established. Thus, it is recommended that you do not breastfeed while receiving Avastin treatment and for an additional 6 months after your last dose. If you are currently breastfeeding or intend to do so, discussing alternative and nutritious feeding methods with your doctor is a prudent course of action. Your doctor can provide guidance to ensure the well-being of both you and your child.

Side Effects of Bevacizumab in Pediatric (Children)

While clinical experience with bevacizumab in pediatric patients remains some what limited, the data available thus far suggests that bevacizumab appears to be a safe option for children. Adverse effects associated with its use in pediatric populations seem to be well manageable. Nonetheless, as with any medical treatment, close monitoring and consultation with healthcare professionals are essential to ensure the well-being and safety of pediatric patients receiving bevacizumab.

Side Effects of Bevacizumab in Geriatric Age (Elderly individuals)

Heart disease was less prevalent among individuals who were not administered bevacizumab. In older patients, the combination of bevacizumab with chemotherapy is associated with an increased likelihood of experiencing grade 3–5 toxicity compared to those who solely receive chemotherapy.

In case of a medical emergency, please seek immediate medical assistance or contact the Poison Help Line at 1-800-222-1222. Information is also available online at poisonhelp.org. Nevertheless, if you are experiencing severe symptoms, please do not hesitate to dial 911 (or your Local Emergency Number) immediately or proceed to the nearest emergency room for immediate medical attention. Your safety and well-being are paramount.