THERAPEUTICS

Brands

• Avastin

Generic?

• No

Class

• Antineoplastic agent

Commonly Prescribed for

(FDA approved in bold)

• Monotherapy for glioblastoma following prior therapy

• Metastatic colorectal cancer

• Metastatic renal cell carcinoma

• Metastatic breast cancer

• Non-squamous non-small cell lung cancer

• Schwannomatosis

• Ovarian cancer

• Age-related macular degeneration

How the Drug Works

• A recombinant humanized monoclonal immunoglobulin (IgG1) that binds to vascular endothelial growth factor (VEGF) and prevents the interaction of VEGF with its receptors (Flt-1 and KDR) on the surface of endothelial cells. It downregulates angiogenesis, improves vascular normalization, and enhances the efficacy of both radiotherapy and chemotherapy

How Long Until It Works

• Days to weeks. May rapidly reduce peritumoral edema, but the actual tumor shrinking effect may take months

If It Works

• Continue every 2 weeks

If It Doesn't Work

• Usually used for symptomatic glioblastomas in an advanced stage but other salvage therapies can be considered depending on the clinical situation

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Generally given to ill and symptomatic patients. Usually given along with dexamethasone, but bevacizumab may allow tapering of corticosteroids

• May be given along with temozolomide, although this is not standard practice

• Coadministration with irinotecan may increase survival

Tests

• Monitor blood pressure (may increase) during treatment

• Urinalysis for proteinuria

• CBC and hepatic function testing during treatment are required

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Many serious AEs (poor wound healing, severe GI complications) are directly related to inhibition of angiogenesis

Notable AEs

• Epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, exfoliative dermatitis

• Less common: rash, diarrhea, thrombocytopenia, neutropenia

Life-Threatening or Dangerous AEs

• Wound healing delays or dehiscence, CSF leak, necrotizing fasciitis

• Hypertensive crisis

• Arterial or venous thromboembolic events

• Severe hemorrhage including retroperitoneal

• Febrile neutropenia, pancytopenia

• Congestive heart failure (rare)

• Hepatotoxicity (rare)

• Ovarian failure

• Gallbladder perforation