What is the dosage and usage of Bevacizumab (Avastin) in cancer treatment?

From the Guidelines

Bevacizumab (Avastin) is typically administered intravenously at doses ranging from 5-15 mg/kg every 2-3 weeks, with specific dosing dependent on the cancer type being treated, and the most recent evidence suggests that for colorectal cancer, the standard dose is 5-10 mg/kg every 2 weeks in combination with chemotherapy 1.

Key Considerations

• The dosage and usage of Bevacizumab can vary based on the type of cancer being treated, with different dosing regimens for colorectal cancer, non-small cell lung cancer, glioblastoma, and ovarian cancer.
• Bevacizumab works by inhibiting vascular endothelial growth factor (VEGF), preventing the formation of new blood vessels that supply tumors with nutrients and oxygen, thereby slowing tumor growth.
• Patients should be monitored for potential side effects including hypertension, proteinuria, impaired wound healing, and rare but serious complications like gastrointestinal perforation or hemorrhage.
• Blood pressure should be controlled before starting treatment, and surgery should be avoided for at least 6 weeks after the last dose due to wound healing concerns, as recommended by the most recent guidelines 1.

Dosage and Administration

• For colorectal cancer, the standard dose is 5-10 mg/kg every 2 weeks in combination with chemotherapy.
• Treatment duration varies by cancer type and response, often continuing until disease progression or unacceptable toxicity.

Side Effects and Precautions

• Patients should be monitored for potential side effects including hypertension, proteinuria, impaired wound healing, and rare but serious complications like gastrointestinal perforation or hemorrhage.
• Bevacizumab may interfere with wound healing, and an interval of at least 6 weeks between the last dose of bevacizumab and elective surgery is recommended 1.

Recent Evidence

• A meta-analysis of 6 randomized clinical trials found that bevacizumab gave a progression-free survival (PFS) and overall survival (OS) advantage in the first-line treatment of metastatic colorectal cancer (mCRC) 1.
• The addition of bevacizumab to chemotherapy is associated with a higher incidence of treatment-related mortality than chemotherapy alone, with hemorrhage, neutropenia, and gastrointestinal perforation being the most common causes of fatality 1.
• The continuation of bevacizumab after progression on bevacizumab was associated with a longer overall survival (OS) and a longer post-progression OS in a community oncology setting 1.

From the FDA Drug Label

1. DOSAGE AND ADMINISTRATION
2. 1 Important Administration Information 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.
3. 2 Metastatic Colorectal Cancer The recommended dosage when Avzivi is administered in combination with intravenous fluorouracil-based chemotherapy is: • 5 mg/kg intravenously every 2 weeks in combination with bolus-IFL. • 10 mg/kg intravenously every 2 weeks in combination with FOLFOX4. • 5 mg/kg intravenously every 2 weeks or 7. 5 mg/kg intravenously every 3 weeks in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy in patients who have progressed on a first-line bevacizumab product-containing regimen. 2.3 First-Line Non-Squamous Non-Small Cell Lung Cancer The recommended dosage is 15 mg/kg intravenously every 3 weeks in combination with carboplatin and paclitaxel.
4. 4 Recurrent Glioblastoma The recommended dosage is 10 mg/kg intravenously every 2 weeks. 2.5 Metastatic Renal Cell Carcinoma The recommended dosage is 10 mg/kg intravenously every 2 weeks in combination with interferon alfa.
5. 6 Persistent, Recurrent, or Metastatic Cervical Cancer The recommended dosage is 15 mg/kg intravenously every 3 weeks in combination with paclitaxel and cisplatin or in combination with paclitaxel and topotecan.
6. 7 Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer Recurrent Disease Platinum Resistant The recommended dosage is 10 mg/kg intravenously every 2 weeks in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan (every week). The recommended dosage is 15 mg/kg intravenously every 3 weeks in combination with topotecan (every 3 weeks).

The dosage and usage of Bevacizumab (Avastin) in cancer treatment are as follows:

• Metastatic Colorectal Cancer: 5 mg/kg intravenously every 2 weeks or 10 mg/kg intravenously every 2 weeks, depending on the chemotherapy regimen.
• First-Line Non-Squamous Non-Small Cell Lung Cancer: 15 mg/kg intravenously every 3 weeks in combination with carboplatin and paclitaxel.
• Recurrent Glioblastoma: 10 mg/kg intravenously every 2 weeks.
• Metastatic Renal Cell Carcinoma: 10 mg/kg intravenously every 2 weeks in combination with interferon alfa.
• Persistent, Recurrent, or Metastatic Cervical Cancer: 15 mg/kg intravenously every 3 weeks in combination with paclitaxel and cisplatin or paclitaxel and topotecan.
• Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer: 10 mg/kg intravenously every 2 weeks or 15 mg/kg intravenously every 3 weeks, depending on the chemotherapy regimen. Key dosage modifications for adverse reactions include:
• Discontinuing Avzivi for gastrointestinal perforations, fistulae, necrotizing fasciitis, hemorrhage, thromboembolic events, hypertensive crisis, posterior reversible encephalopathy syndrome, nephrotic syndrome, and congestive heart failure.
• Withholding Avzivi for wound healing complications, recent history of hemoptysis, and proteinuria greater than or equal to 2 grams per 24 hours. 2

From the Research

Dosage and Usage of Bevacizumab in Cancer Treatment

• Bevacizumab is administered intravenously, with a dose of 5 mg/kg or 10 mg/kg every 2 weeks, depending on the type of cancer and the treatment regimen 3, 4, 5.
• In metastatic colorectal cancer, bevacizumab is typically used in combination with chemotherapy, such as FOLFIRI, with a dose of 5 mg/kg every 2 weeks 3.
• In non-small cell lung cancer, bevacizumab is used in combination with chemotherapy, such as carboplatin and paclitaxel, with a dose of 10 mg/kg every 2 weeks 4.
• In breast cancer, bevacizumab is used in combination with chemotherapy, such as paclitaxel, with a dose of 10 mg/kg every 2 weeks 4, 6.
• The dosage and administration of bevacizumab may vary depending on the specific cancer type, treatment regimen, and patient population 5, 7.

Efficacy and Safety of Bevacizumab

• Bevacizumab has been shown to improve progression-free survival and overall survival in patients with various types of cancer, including metastatic colorectal cancer, non-small cell lung cancer, and breast cancer 3, 4, 7.
• The most common adverse events associated with bevacizumab include hypertension, proteinuria, hemorrhage, wound healing complications, and thromboembolic events 4, 5, 6, 7.
• Bevacizumab has a well-defined tolerability profile, and adverse events are generally manageable with appropriate monitoring and treatment 7.

Clinical Trials and Studies

• numerous clinical trials and studies have investigated the efficacy and safety of bevacizumab in various types of cancer, including metastatic colorectal cancer, non-small cell lung cancer, breast cancer, and others 3, 4, 5, 6, 7.
• These studies have demonstrated the potential of bevacizumab to improve treatment outcomes and quality of life for patients with advanced cancer 3, 4, 7.