From the Guidelines
Bevacizumab is typically dosed at 5 mg/kg every 2 weeks when combined with chemotherapy for metastatic colorectal cancer, as indicated by the most recent and highest quality study 1.
Dosing Considerations
The dosing of bevacizumab can vary based on the specific condition being treated and the chemotherapy regimen used.
- For metastatic colorectal cancer, the common dose is 5-10 mg/kg every 2 weeks when combined with chemotherapy, with 5 mg/kg being an appropriate dose in second-line treatment, as shown in the EAGLE trial 1.
- The medication requires careful monitoring for side effects, including hypertension, proteinuria, impaired wound healing, and rare but serious complications like gastrointestinal perforation or hemorrhage.
Treatment Duration and Monitoring
Treatment duration varies by cancer type but generally continues until disease progression or unacceptable toxicity.
- Blood pressure should be monitored regularly, and treatment should be temporarily suspended before elective surgeries.
- The medication works by inhibiting vascular endothelial growth factor (VEGF), thereby reducing tumor blood vessel formation and growth.
Recent Guidelines and Studies
Recent studies, including the TML trial and the BEBYP trial, have shown that the continuation of bevacizumab in second-line therapy offers a modest but statistically significant overall survival benefit 1.
- The NCCN Guidelines for Colon and Rectal Cancers recommend the continuation of bevacizumab in second-line treatment options, and it may be added to any regimen that does not contain another targeted agent 1.
From the FDA Drug Label
2.2 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.
2.4 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.
2.6 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.
2.7 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 dosing of bevacizumab varies by indication:
- Metastatic Colorectal Cancer: 5 mg/kg every 2 weeks or 10 mg/kg every 2 weeks, depending on the chemotherapy regimen.
- First-Line Non-Squamous Non-Small Cell Lung Cancer: 15 mg/kg every 3 weeks.
- Recurrent Glioblastoma: 10 mg/kg every 2 weeks.
- Metastatic Renal Cell Carcinoma: 10 mg/kg every 2 weeks.
- Persistent, Recurrent, or Metastatic Cervical Cancer: 15 mg/kg every 3 weeks.
- Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer: 10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks, depending on the chemotherapy regimen. 2
From the Research
Bevacizumab Dosing
- Bevacizumab is typically administered at a dose of 2.5 mg/kg per week 3 or 5 mg/kg or 7.5 mg/kg every 2-3 weeks 4.
- The dose of bevacizumab can be infused safely over 10 minutes for doses of 5 or 7.5 mg/kg in metastatic colorectal cancer patients 4.
- Bevacizumab pharmacokinetics have been evaluated in various studies, with a two-compartment model best describing the data 5.
- The population estimates of clearance, central volume of distribution, and half-life for a typical 70-kg patient are 9.01 mL/h, 2.88 L, and 19.6 days, respectively 5.
- Bevacizumab clearance and volume of distribution increase with body weight and are higher in males than females 5.
- There is no significant difference in bevacizumab pharmacokinetics between Asian and non-Asian patients 5.