Recommended Use and Dosage of Bevacizumab in Cancer Treatment
Bevacizumab is recommended in combination with chemotherapy for several cancer types, with specific dosages based on cancer type: 5-10 mg/kg every 2 weeks or 7.5-15 mg/kg every 3 weeks, depending on the specific cancer and chemotherapy regimen. 1
Approved Indications and Dosing
Metastatic Colorectal Cancer
- First-line therapy:
- 5 mg/kg IV every 2 weeks in combination with bolus-IFL
- 10 mg/kg IV every 2 weeks in combination with FOLFOX4 1
- Second-line therapy (after progression on bevacizumab-containing regimen):
- 5 mg/kg IV every 2 weeks or 7.5 mg/kg IV every 3 weeks with fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy 1
- Provides modest but statistically significant survival benefit when added to first-line chemotherapy 2
- Should not be used in perioperative stage IV setting 2
Non-Small Cell Lung Cancer (NSCLC)
- First-line therapy for non-squamous NSCLC:
- 15 mg/kg IV every 3 weeks in combination with carboplatin and paclitaxel 1
- Contraindicated in patients with squamous histology due to risk of severe hemoptysis 2
- Carboplatin/paclitaxel is the preferred chemotherapy combination when using bevacizumab 2
Other FDA-Approved Indications
- Recurrent Glioblastoma: 10 mg/kg IV every 2 weeks 1
- Metastatic Renal Cell Carcinoma: 10 mg/kg IV every 2 weeks with interferon alfa 1
- Cervical Cancer: 15 mg/kg IV every 3 weeks with paclitaxel and cisplatin/topotecan 1
- Ovarian Cancer: 10 mg/kg IV every 2 weeks or 15 mg/kg IV every 3 weeks depending on chemotherapy regimen 1
Important Safety Considerations
Timing Around Surgery
- Withhold bevacizumab for at least 28 days prior to elective surgery 1
- Wait at least 6 weeks (2 half-lives) between last dose and any elective surgery 2
- Delay reinitiation for 6-8 weeks after surgery 2
- Retrospective studies show wound healing complications increase when surgery is performed while on bevacizumab (13% vs 3.4% with chemotherapy alone) 2
Contraindications and Precautions
- Avoid in patients with:
Monitoring for Adverse Events
- Common adverse events requiring monitoring:
Special Populations and Considerations
Brain Metastases
- Previously treated, stable brain metastases may be safely treated with bevacizumab 2
- The PASSPORT study showed no CNS hemorrhages in patients with treated, stable brain metastases receiving bevacizumab 2
Continuation Beyond Progression
- In metastatic colorectal cancer, continuing bevacizumab beyond first progression with a different chemotherapy regimen provides modest survival benefit (11.2 vs 9.8 months) 2
- No evidence of a "rebound effect" when discontinuing bevacizumab 2
Efficacy Considerations
- Bevacizumab improves progression-free survival and/or overall survival when added to standard chemotherapy in multiple cancer types 3
- In metastatic colorectal cancer, benefit appears more evident with irinotecan-based regimens than with oxaliplatin-based regimens 2
- Combination therapy involving multiple biologics (anti-EGFR agents with bevacizumab) is not recommended 2
Common Pitfalls to Avoid
- Do not use bevacizumab with anti-EGFR agents (cetuximab or panitumumab) simultaneously 2
- Do not continue bevacizumab within 6 weeks of planned surgery 2
- Do not use in patients with squamous NSCLC due to risk of fatal pulmonary hemorrhage 2
- Do not restart too soon after surgery (wait 6-8 weeks minimum) 2
- Do not ignore hypertension - requires monitoring and management 1