Bevacizumab (Avastin, Genentech) is a VEGF inhibitor used in the treatment of metastatic CRC, non–small cell lung cancer (NSCLC), metastatic renal cell carcinoma and metastatic cervical cancer. The drug is administered as an IV infusion. This section explains the common adverse reactions as well as warnings, precautions and other contraindications associated with its use.
Common adverse reactions
Warnings and precautions
Drug interactions and other contraindications
Bevacizumab common adverse reactions
Adverse reactions reported by at least 10% of patients receiving bevacizumab in clinical trials included epistaxis (nosebleed), headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, back pain and exfoliative dermatitis.
Bevacizumab warnings and precautions
Gastrointestinal perforation is a serious and life-threatening adverse event that has been reported in association with bevacizumab treatment. Most cases of perforation occurred within the first 50 days of treatment. The rate of GI perforation in clinical trials was highest among patients with recurrent or metastatic cervical cancer who had been treated previously with pelvic radiation. Symptoms of GI perforation include abdominal pain, nausea, vomiting, constipation and fever. Patients with GI perforation should discontinue bevacizumab.
The formation of GI, tracheoesophageal, bronchopleural, rectovaginal and other fistulas has been reported with bevacizumab treatment. Fistulas involving internal organs should result in discontinuation of bevacizumab.
Patients receiving bevacizumab may experience hemorrhage, including GI and pulmonary hemorrhage. Treatment should be discontinued in the event of hemorrhage.
Other potentially serious adverse events associated with bevacizumab include venous and arterial thromboembolism, hypertension and proteinuria.
Bevacizumab drug interactions and other contraindications
One limitation of use is included in the Avastin prescribing information: bevacizumab is not indicated for adjuvant treatment of colon cancer.
As bevacizumab may interfere with wound healing, patients undergoing surgical procedures should not start bevacizumab for at least 28 days after surgery.