From the Guidelines
The recommended duration for withholding Avastin (bevacizumab) prior to surgery is at least 6 weeks, due to its potential impact on wound healing 1. For patients receiving the standard dose of 5-10 mg/kg every 2 weeks, it is advised to hold the medication for a minimum of 28-42 days before undergoing elective surgery to minimize the risk of perioperative complications. This timeframe allows for sufficient clearance of the drug and reduction of its anti-angiogenic effects, which can impair wound healing.
Key Considerations
- The panel recommends an interval of at least 6 weeks between the last dose of bevacizumab and any elective surgery 1.
- Reinitiation of bevacizumab should be delayed at least 6 to 8 weeks postoperatively 1.
- Bevacizumab may interfere with wound healing, and its use should be carefully considered in patients undergoing surgery 1.
- The risk of stroke and other arterial events is increased in patients receiving bevacizumab, especially in those ≥65 years 1.
- Gastrointestinal perforation is a rare but important side effect of bevacizumab therapy in patients with CRC 1.
Summary of Evidence
The evidence from multiple studies and guidelines suggests that withholding bevacizumab for at least 6 weeks before surgery is recommended to minimize the risk of perioperative complications 1.
From the FDA Drug Label
Withhold for at least 28 days prior to elective surgery. Do not administer Avzivi until at least 28 days following major surgery and until adequate wound healing. The recommended duration to withhold Avastin (Bevacizumab) before surgery is at least 28 days 2.
From the Research
Recommended Duration to Withhold Avastin (Bevacizumab) Before Surgery
The recommended duration to withhold Avastin (Bevacizumab) before surgery is at least 6 to 8 weeks (>40 days) after cessation, as suggested by current literature 3. This is due to the potential adverse effects of bevacizumab on surgical wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection.
Key Findings
- Bevacizumab should be started at least four weeks after surgery or discontinued for at least six to eight weeks before elective surgery to minimize the risk of bleeding or impaired wound healing 4.
- Patients who underwent major surgery during bevacizumab therapy experienced increased wound healing complications, with 13% of bevacizumab-treated patients experiencing complications compared to 3.4% of control patients 5.
- Postoperative reinitiation of bevacizumab must wait > or =28 days to prevent an increased risk of wound healing complications, and the surgical incision should be fully healed 3.
- Studies have shown that surgery can be performed on patients with metastatic breast cancer undergoing bevacizumab therapy with a low risk of severe bleeding or wound-healing complications post surgery, if current labelling recommendations are adhered to 6.
Specific Recommendations
- For patients undergoing craniotomy, it is recommended to perform repeated craniotomy more than 28 days after the last administered dose of bevacizumab whenever possible 7.
- Bevacizumab-treated patients should be monitored for wound healing complications, and the treatment should be discontinued if any complications occur.
- The half-life of bevacizumab is 20 days, and patients should wait at least 6 to 8 weeks after cessation before undergoing surgery 3.