bevacizumab: clinical use

Prescribing considerations

• Use under an experienced antineoplastic prescriber and record the biological product name and batch number.
• Control pre-existing hypertension before starting and consider aneurysm or arterial-dissection risk factors.
• Review gastrointestinal inflammation, prior pelvic radiation, bleeding history, recent haemoptysis, thromboembolic history, cardiovascular disease and concurrent anticoagulation.
• Do not initiate after major surgery until the wound is fully healed; withhold for elective surgery and wound-healing complications.
• Consider oral assessment and preventive dentistry, especially with current or previous intravenous bisphosphonates.
• Discuss possible ovarian failure and fertility preservation before treatment where relevant.
• Safety and efficacy for the licensed cancer indications are not established in people under 18.

Contraindications and cautions

• Hypersensitivity to bevacizumab or an excipient.
• Hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanised antibodies.
• Pregnancy.

Monitoring

• Blood pressure before and throughout treatment.
• Urine protein before and during treatment.
• Evidence of bleeding, arterial or venous thrombosis, gastrointestinal perforation or fistula, wound-healing problems and infection.
• Infusion or hypersensitivity reactions during and after administration.
• Neurological symptoms suggesting posterior reversible encephalopathy syndrome.
• Oral or jaw symptoms in patients with dental or bisphosphonate risk factors.

Clinical pharmacology

Bevacizumab neutralises VEGF-A, preventing VEGFR-1 and VEGFR-2 activation. Like endogenous IgG, it is mainly cleared by proteolytic catabolism rather than renal or hepatic excretion and has a long terminal half-life.

Formulation and product differences

• Selected Alymsys is a single-use intravenous concentrate requiring aseptic dilution with sodium chloride solution; it must not be shaken or diluted with glucose solutions.
• It contains polysorbate 20 and is considered essentially sodium-free.
• This oncology formulation is not intended for intravitreal administration.

Solution for infusion

Route: Intravenous

Strengths: 25 mg/mL, 100 mg, 100 mg/4 mL, 400 mg, 400 mg/16 mL