BEVACIZUMAB
| BEVACIZUMAB (be-va-ci-zu'mab) Avastin Classifications: antineoplastic agent; biologic response modifier; monoclonal antibody; Therapeutic: antineoplastic; monoclonal antibody Pregnancy Category: C |
Availability
25 mg/mL injection
Action
Binds to vascular endothelial growth factor (VEGF) and prevents the interaction of VEGF to its receptors on the surface of endothelial cells. This blocks endothelial cell proliferation and new blood vessel formation in tumor cells.
Therapeutic Effect
Believed to cause reduction of microvascularization in the tumor inhibiting the progression of metastatic disease.
Uses
Metastatic colorectal cancer, non small cell lung cancer.
Unlabeled Uses
Metastatic renal cell cancer, age-related macular degeneration.
Contraindications
Pregnancy (category C), lactation, neonates; nephrotic syndrome; active bleeding, GI perforation; surgery within 28 d; dental work within 20 d. Safety and effectiveness in children and infants are not established.
Cautious Use
Hypersensitivity to bevacizumab; renal disease; hypertension, history of arterial thromboembolic, cardiovascular, or cerebrovascular disease.
Route & Dosage
| Metastatic Colorectal Cancer Adult; : IV 5–10 mg/kg q14d until disease progression; in conjunction with other chemotherapy Non Small Cell Lung Cancer Adult: IV 15 mg/kg q3wk |
Administration
| Intravenous PREPARE: IV Infusion: Withdraw the desired dose of 5 mg/kg and dilute in 100 mL of NS injection. Do not shake and do NOT mix or administer with dextrose solutions. Discard any unused portion. ADMINISTER: IV Infusion: DO NOT administer IV push or bolus. Infuse first dose over 90 min; if well tolerated, infuse second dose over 60 min; if well tolerated, infuse all subsequent doses over 30 min. INCOMPATIBILITIES Solution/additive: Dextrose-containing solutions. Y-site: Dextrose-containing solutions. |
- Store diluted solution at 2°–8° C (36°–46° F) for up to 8 h. Store vials at 2°–8° C (36°–46° F) and protect from light.
Adverse Effects (≥1%)
Body as a Whole: Asthenia, pain, wound dehiscence, tracheosophageal (TE) fistula formation. CNS: Syncope, headache, dizziness, confusion, abnormal gait, leukoencephalopathy. CV: DVT, hypertension, heart failure, intra-abdominal thrombosis, cerebrovascular events. GI: Abdominal pain, diarrhea, constipation, nausea, vomiting, anorexia, stomatitis, dyspepsia, weight loss, flatulence, dry mouth, colitis, gastrointestinal perforation. Hematologic: Leukopenia, neutropenia, thrombocytopenia, hemorrhage, thromboembolism. Metabolic: Hypokalemia, hyperbilirubinemia. Musculoskeletal: Myalgia. Respiratory: Upper respiratory infection, epistaxis, dyspnea, hemoptysis. Skin: Exfoliative dermatitis, alopecia. Special Senses: Taste disorder, increased tearing. Urogenital: Proteinuria, urinary frequency/urgency.Interactions
Drug: None reported at this time.Pharmacokinetics
Half-Life: 20 d (11–50 d).Nursing Implications
Assessment & Drug Effects
- Monitor for S&S of an infusion reaction (hypersensitivity); infusion should be interrupted in all patients with severe infusion reactions and appropriate therapy instituted.
- Monitor BP at least every 2–3 wk; if hypertension develops, monitor more frequently, even after discontinuation of bevacizumab.
- Withhold drug and promptly notify physician for S&S of CHF, hemorrhage (e.g., epistaxis, hemoptysis, or GI bleeding), or unexplained abdominal pain.
- Lab tests: Urinalysis for proteinuria and 24 h urine if protein 2+ or greater.
- Monitor for dizziness, lightheadedness, or loss of balance. Take appropriate safety measures.
Patient & Family Education
- Report any of the following to the physician: bloody or black, tarry stool; changes in patterns of urination; swelling of legs or ankles; increased shortness of breath; severe abdominal pain; change in mental awareness, inability to talk or move one side of the body.
- Women of childbearing age should use effective birth control while receiving bevacizumab.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug