From the Guidelines
Avastin (bevacizumab) can cause several significant complications, including gastrointestinal perforations, severe bleeding, impaired wound healing, hypertension, and blood clots, which can impact morbidity, mortality, and quality of life. The most serious complications of Avastin include:
- Gastrointestinal perforations
- Severe bleeding
- Impaired wound healing
- Hypertension that can become severe
- Blood clots including stroke, heart attack, and deep vein thrombosis Patients may also experience proteinuria (protein in urine) that can progress to nephrotic syndrome, and in rare cases, posterior reversible encephalopathy syndrome characterized by headache, confusion, and visual changes 1. Other common side effects include fatigue, diarrhea, decreased appetite, and hand-foot syndrome. Avastin works by blocking vascular endothelial growth factor (VEGF), which inhibits the formation of new blood vessels that tumors need to grow, but this mechanism also affects normal blood vessel function throughout the body, explaining many of its side effects 1. Patients receiving Avastin should have regular blood pressure monitoring, urinalysis to check for protein, and should report any unusual symptoms promptly, and surgery should be planned carefully, with Avastin typically discontinued 4-6 weeks before procedures and resumed only after adequate wound healing 1. The risk of stroke and other arterial events is increased in patients receiving bevacizumab, especially in those aged ≥65 years, and gastrointestinal perforation is a rare but important side effect of bevacizumab therapy in patients with CRC 1. Preclinical studies suggested that cessation of anti-VEGF therapy might be associated with accelerated recurrence, more aggressive tumors on recurrence, and increased mortality, but recent results from the NSABP Protocol C-08 trial found no difference in recurrence, mortality, or mortality 2 years after recurrence between patients receiving bevacizumab versus those in the control arm 1. Overall, the use of Avastin requires careful consideration of its potential complications and close monitoring of patients to minimize its risks and maximize its benefits in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Gastrointestinal Perforations and Fistulae: bevacizumab products may increase the risk of developing gastrointestinal perforations and fistulae. Surgery and Wound Healing Complications: bevacizumab products can increase the risk of wound healing complications. Hemorrhage: bevacizumab products can increase the risk of hemorrhage. Arterial and Venous Thromboembolic Events: bevacizumab products increase the risk of arterial and venous thromboembolic events. Hypertension: bevacizumab products can increase blood pressure. Posterior Reversible Leukoencephalopathy Syndrome: Posterior reversible encephalopathy syndrome (PRES) has been associated with bevacizumab products treatment. Renal Injury and Proteinuria: bevacizumab products increase the risk of proteinuria and renal injury, including nephrotic syndrome. Infusion-Related Reactions: bevacizumab products can cause infusion-related reactions. Congestive Heart Failure: bevacizumab products can increase the risk of developing congestive heart failure. Embryo-Fetal Toxicity: Advise female patients that bevacizumab products may cause fetal harm and to inform their healthcare provider with a known or suspected pregnancy. Ovarian Failure: bevacizumab products may lead to ovarian failure. Lactation: Advise women not to breastfeed during treatment with Avzivi and for 6 months after the last dose.
The complications of Avastin (bevacizumab) include:
- Gastrointestinal perforations and fistulae
- Surgery and wound healing complications
- Hemorrhage
- Arterial and venous thromboembolic events
- Hypertension
- Posterior reversible leukoencephalopathy syndrome (PRES)
- Renal injury and proteinuria
- Infusion-related reactions
- Congestive heart failure
- Embryo-fetal toxicity
- Ovarian failure
- Lactation complications 2 2
From the Research
Avastin Complications
- Avastin (bevacizumab) is an anti-angiogenic agent that has been associated with several complications, including:
- Hypertension
- Proteinuria
- Thromboembolic events
- Bleeding
- Cardiac toxicity
- Wound-healing complications
- Gastrointestinal perforations 3
- The risk of wound-healing complications is higher with neoadjuvant than adjuvant bevacizumab use and may be decreased by extending the bevacizumab-surgery interval 4
- Bevacizumab has been associated with multiple complications in regard to wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection 5
- Predictors for the development of thromboembolic events in cancer patients treated with bevacizumab include serum albumin level and diabetes mellitus 6
- Bevacizumab and ramucirumab are associated with a significant increase in the risk of all-grade and high-grade bleeding, with bevacizumab increasing the risk of high-grade bleeding and ramucirumab not showing a significant difference in the risk of high-grade bleeding 7
Specific Complications
- Thromboembolic events: bevacizumab has been associated with an increased risk of thromboembolic events, with predictors including serum albumin level and diabetes mellitus 6
- Bleeding: bevacizumab and ramucirumab are associated with a significant increase in the risk of all-grade and high-grade bleeding, with bevacizumab increasing the risk of high-grade bleeding and ramucirumab not showing a significant difference in the risk of high-grade bleeding 7
- Wound-healing complications: bevacizumab has been associated with multiple complications in regard to wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection, with the risk being higher with neoadjuvant than adjuvant bevacizumab use 4, 5