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AVASTIN

Dosing & Uses

Metastatic Colorectal Cancer


Indicated for first-line and second-line treatment for metastatic colorectal carcinoma (in
combination with 5-fluorouracil-based chemotherapy)
Fluorouracil based chemotherapy: 5-10 mg/kg IV q2Weeks
Administer 5 mg/kg when used in combination with bolus-IFL (ie, irinotecan, 5-FU, leucovorin)
Administer 10 mg/kg when used in combination with FOLFOX4 (ie, oxaliplatin, 5-FU,
leucovorin)
Second-line continuation treatment with bevacizumab

Indicated for second-line treatment in patients who have progressed on a first-line


bevacizumab-containing regimen

Use bevacizumab in combination with a fluoropyrimidine (eg, 5-FU, capecitabine) plus


irinotecan or oxaliplatin-based chemotherapy

5 mg/kg IV q2Weeks or 7.5 mg/kg IV q3Weeks

Nonsmall Cell Lung Cancer


Indicated for unresectable, locally advanced, recurrent or metastatic, nonsquamous NSCLC in
combination wtih carboplatin and paclitaxel
15 mg/kg IV q3wk

Breast Cancer
Indication for metastatic breast cancer (HER2-negative) revoked by FDA in November 2011 due
to failure to delay tumor growth or provide survival benefit

Renal Cell Carcinoma


Indicated for metastatic renal cell carcinoma (with interferon alfa-2a)

10 mg/kg IV q2Weeks (with interferon alfa-2a or as monotherapy)

Cervical Cancer
Indicated as part of a combination chemotherapy regimen for persistent, recurrent, or metastatic
carcinoma of the cervix
15 mg/kg IV infusion q3wk

Administer in combination with 1 of the following chemotherapy regimens: paclitaxel and


cisplatin, or paclitaxel and topotecan

Ovarian, Fallopian Tube, or Peritoneal Cancer


Indicated in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan is
indicated for the treatment of patients with platinum-resistant recurrent epithelial ovarian,
fallopian tube, or primary peritoneal cancer who received no more than 2 prior chemotherapy
regimens
10 mg/kg IV q2Weeks in combination with 1 of the following IV chemotherapy regimens:
paclitaxel, pegylated liposomal doxorubicin, or topotecan (weekly) OR
15 mg/kg IV q3Weeks in combination with topotecan (q3Weeks)

Glioblastoma
Indicated for glioblastoma as a single agent for patients with progressive disease following prior
therapy
10 mg/kg IV q2wk

Exudative ARMD
Off-label indication for exudative age-related macular degeneration
Off-label: 1.25 mg (in 0.05mL of solution) administered by intravitreal injection once monthly
Reference: CATT Research Group, N Engl J Med 2011;364:1897-1908
The need to repackage the drug from the available size vial into a smaller doses increases risk for
transmission of infection if improper aseptic technique occurrs

Adverse Effects

Cardiovascular: Pulmonary hypertension, RPLS, mesenteric venous occlusion


Osteonecrosis of the jaw
Eye disorders (from unapproved intravitreal use for treatment of various ocular disorders):
Permanent loss of vision, endophthalmitis (infectious and sterile), intraocular inflammation,
retinal detachment, increased IOP, hemorrhage (including conjunctival, vitreous hemorrhage, or
retinal hemorrhage), vitreous floaters, ocular hyperemia, ocular pain or discomfort
Gastrointestinal: Gastrointestinal ulcer, intestinal necrosis, anastomotic ulceration
Hemic and lymphatic: Pancytopenia
Hepatobiliary disorders: Gallbladder perforation
Infections and infestations: Necrotizing fasciitis, usually secondary to wound healing
complications, gastrointestinal perforation or fistula formation
Musculoskeletal: Osteonecrosis of the jaw
Renal: Renal thrombotic microangiopathy
Respiratory: Nasal septum perforation
Dysphonia
Systemic events (from unapproved intravitreal use for treatment of various ocular disorders):
Arterial thromboembolic events, hypertension, gastrointestinal perforation, hemorrhage
Non-mandibular osteonecrosis and posterior reversible encephalopathy syndrome (PRES)

Pharmacology
Mechanism of Action

Recombinant humanized monoclonal antibody to VEGF; blocks the angiogenic molecule VEGF
thereby inhibiting tumor angiogenesis, starving tumor of blood and nutrients
Pharmacokinetics

Half-Life: 20 days (range 11-50 days)

Metabolism: N/A
Excretion: N/A