Bevacizumab
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Trade Name
Avastin (primary brand name); generic bevacizumab. Biosimilars include Mvasi and Zirabev
Classification
Monoclonal antibody; anti-angiogenic agent; antineoplastic
Dosage/Route
- * Dosage: Available as 100 mg/4 mL or 400 mg/16 mL vials (25 mg/mL)
- * Route: Intravenous (IV) infusion
Usual Dosage
- * Varies by cancer type:
- – Colorectal Cancer: 5-10 mg/kg IV every 2 weeks
- – Lung Cancer (NSCLC): 15 mg/kg IV every 3 weeks
- – Glioblastoma: 10 mg/kg IV every 2 weeks
- – Cervical/Ovarian Cancer: 10-15 mg/kg IV every 2-3 weeks
- * Given with chemotherapy; dose based on weight, adjusted for toxicity
Mechanism of Action
Binds to vascular endothelial growth factor (VEGF), inhibiting its interaction with receptors on endothelial cells. This prevents angiogenesis (new blood vessel formation), starving tumors of oxygen and nutrients, slowing growth
Side Effects & Adverse Effects
- * Side Effects: Hypertension, fatigue, proteinuria, epistaxis (nosebleeds), headache
- * Adverse Effects:
- – Hemorrhage (severe bleeding, e.g., GI, pulmonary)
- – GI perforation (rare, life-threatening)
- – Thromboembolism (stroke, MI, DVT)
- – Wound healing delay ( boxed warning)
- – Posterior reversible encephalopathy syndrome (PRES) (rare; seizures, confusion)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor BP (treat hypertension; hold if uncontrolled)
- – Assess for bleeding (nosebleeds, black stools) and proteinuria (urine dipstick)
- – Infuse first dose over 90 min, then 60 min, then 30 min if tolerated; never IV push
- – Stop 28 days before/after surgery (wound healing risk)
- * Teachings:
- – Report bleeding, severe headache, or abdominal pain
- – Monitor BP at home if hypertensive
- – Avoid invasive procedures (e.g., dental) during treatment
- – Expect fatigue; plan rest periods
Indication for This Patient
- * Metastatic colorectal cancer (with chemo)
- * Non-small cell lung cancer (NSCLC) (unresectable, with chemo)
- * Glioblastoma (recurrent)
- * Cervical/ovarian cancer (advanced, with chemo)
- * Renal cell carcinoma (metastatic)
Time
- * Timing: Every 2-3 weeks (per protocol)
- * Infusion Time: First dose: 90 min; subsequent: 60 min, then 30 min if no reactions
- * Onset: Tumor response in weeks; half-life ~20 days
