Bevacizumab (Avastin)

General information

Class/mechanism: Monoclonal antibody that inhibits angiogenesis by binding VEGF and preventing the interaction of VEGF with its receptors (Flt-1 and KDR) on the surface of endothelial cells.
Route: IV
Extravasation: neutral

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, Medscape,UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Adenocarcinoma of unknown primary
• Anaplastic glioma
• Breast cancer
• Cervical cancer
• Cholangiocarcinoma
• Colon cancer
• Esophageal cancer
• Follicular lymphoma
• Glioblastoma
• Hepatocellular carcinoma
• Melanoma
• Mesothelioma
• Neuroendocrine tumors
• Non-small cell lung cancer
• Ovarian cancer
• Pancreatic NET
• Renal cell carcinoma
• Small cell lung cancer
• Testicular cancer
• Endometrial cancer
• Vascular sarcoma

Information about counterfeit bevacizumab

• FDA's 2/14/2012 statement about counterfeit Avastin in U.S.
• Genentech's 2/14/2012 statement on counterfeit drug labeled as Avastin (Bevacizumab) in the United States - contains pictures of authentic and counterfeit product
• Authorized specialty distributors, wholesalers and specialty pharmacies for Bevacizumab (Avastin)

Patient drug information

• Bevacizumab (Avastin) patient drug information (Chemocare)
• Brief patient counseling information can be found in the package insert
• Bevacizumab (Avastin) patient drug information (UpToDate)

History of changes in FDA indication

• 2/26/2004: Initial FDA approval, "in combination with intravenous 5-fluorouracil–based chemotherapy...for first- line treatment of patients with metastatic carcinoma of the colon or rectum."
• Subsequently FDA approved for:
  • "Metastatic colorectal cancer, with intravenous 5-fluorouracil–based chemotherapy for first- or second-line treatment."
  • "Metastatic colorectal cancer, with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy for second-line treatment in patients who have progressed on a first-line Avastin containing regimen."
  • "Non-squamous non-small cell lung cancer, with carboplatin and paclitaxel for first line treatment of unresectable, locally advanced, recurrent or metastatic disease."
  • "Glioblastoma, as a single agent for adult patients with progressive disease following prior therapy."
  • "Metastatic renal cell carcinoma with interferon alfa."
• 8/14/2014: FDA approved for treatment of "cervical cancer, in combination with paclitaxel and cisplatin or paclitaxel and topotecan in persistent, recurrent, or metastatic disease."
• 11/14/2014: FDA approved for treatment of "Platinum-resistant recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer, in combination with paclitaxel, pegylated liposomal doxorubicin or topotecan."
• 6/13/2018: FDA approved "for patients with epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with carboplatin and paclitaxel, followed by single-agent bevacizumab, for stage III or IV disease after initial surgical resection."

Also known as

• Generic name: rhuMab-VEGF
• Brand names: Altuzan, Avastin, BevaciRel, Bevarest