Bevacizumab
AVASTIN
Pronunciation: be-va-SIZ-yoo-mab
“A vast tin Beaver sees you, maybe”
What it isVEGF-A-neutralizing monoclonal antibody; IV treatment across colorectal, lung, renal, ovarian, and brain tumors.
Why this oneCompounded, it is the workhorse off-label intravitreal anti-VEGF rather than an on-label ocular agent.
What limits itHypertension, proteinuria, hemorrhage, GI perforation, and poor wound healing require monitoring and perioperative planning.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Metastatic colorectal cancer (with IV fluorouracil-based chemo) | Adults | — | 5 mg/kg q2wk (bolus-IFL) or 10 mg/kg q2wk (FOLFOX4) | — |
| mCRC, 2nd-line after progression on a bevacizumab regimen | Adults | — | 5 mg/kg q2wk or 7.5 mg/kg q3wk (with fluoropyrimidine-irinotecan or -oxaliplatin) | — |
| First-line non-squamous NSCLC (with carboplatin+paclitaxel) | Adults | — | 15 mg/kg q3wk | — |
| Recurrent glioblastoma | Adults | — | 10 mg/kg q2wk | — |
| Metastatic renal cell carcinoma (with interferon alfa) | Adults | — | 10 mg/kg q2wk | — |
| Persistent/recurrent/metastatic cervical cancer (with paclitaxel+cisplatin or paclitaxel+topotecan) | Adults | — | 15 mg/kg q3wk | — |
| Epithelial ovarian/fallopian tube/primary peritoneal cancer, stage III/IV after resection (with carboplatin+paclitaxel, then single agent) | Adults | — | 15 mg/kg q3wk (up to 22 cycles total) | — |
| Platinum-resistant recurrent ovarian/FT/PP cancer | Adults | — | 10 mg/kg q2wk (w/ paclitaxel, PLD, or weekly topotecan) or 15 mg/kg q3wk (w/ q3wk topotecan) | — |
| Platinum-sensitive recurrent ovarian/FT/PP cancer | Adults | — | 15 mg/kg q3wk (w/ carbo+paclitaxel or carbo+gemcitabine, then single agent) | — |
| Unresectable/metastatic hepatocellular carcinoma (with atezolizumab) | Adults | — | 15 mg/kg q3wk after atezolizumab 1,200 mg | — |
Renal Undefined
Hepatic Undefined
Instructions
- IV infusion after dilution in 0.9% NaCl; do not administer or mix with dextrose
- First infusion over 90 min; second over 60 min; subsequent over 30 min if tolerated
- Withhold ≥28 days before elective surgery; do not give for ≥28 days after major surgery and until adequate wound healing
- No dose reductions — withhold or discontinue for adverse reactions (Table 1)
Available strengths
- inj 25 mg/mL
Cautions
- GI perforations and fistulae
- Surgery/wound-healing complications; necrotizing fasciitis
- Hemorrhage (severe/fatal)
- Arterial thromboembolic events
- Venous thromboembolic events
- Hypertension
- Posterior reversible encephalopathy syndrome (PRES)
- Renal injury and proteinuria
- Infusion-related reactions
- Embryo-fetal toxicity
- Ovarian failure
- Congestive heart failure
Adverse reactions
- Epistaxis
- Headache
- Hypertension
- Rhinitis
- Proteinuria
- Taste alteration
- Dry skin
- Hemorrhage
- Lacrimation disorder
- Back pain
- Exfoliative dermatitis
Pregnancy May cause fetal harm (congenital malformations in animals). Advise effective contraception during and for 6 months after last dose.
Lactation No human milk data; do not breastfeed during treatment and for 6 months after the last dose.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 25 mg/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskGastrointestinal perforation, wound-healing complications and hemorrhage