Alternate Name(s):
Avastin®: MVASI® (biosimilar), ZIRABEV® (biosimilar)
Classification:
Recombinant humanized monoclonal antibody
Original Date:
December 2005
Revised Date:
January 2021
Indications:
- Approved for use first-line treatment of patients with metastatic colorectal carcinoma (in combination with chemotherapy), unresectable advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) (in combination with chemotherapy), recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer (in combination with chemotherapy), in relapse or refractory glioblastoma (in combination with chemotherapy).
- Additional off-label usage including; High risk epithelial ovarian, fallopian tube, or primary peritoneal cancer; Refractory colorectal cancer; Cervical cancer; Mesothelioma, hepatocellular carninoma; renal cell carcinoma
- Mvasi and Zirabev are subsequent entry biologic drug. Comparability has been established with the reference product, Avastin; Mvasi and Zirabev are not interchangeable with the reference product
Reconstitution and Stability:
- Different bevacizumab products are not interchangeable
- Available as 25 mg/mL preservative-free injectable solution in vials of 4 mL (100 mg) and 16 mL (400 mg)
- Diluted solutions (final concentration of 1.4-16.5 mg/mL) are stable 24 hours refrigerated or at room temperature.
- Protect from light (STUDY supply must be stored in outer carton to protect from light)
- Store in refrigerator. Do not freeze. Do not shake
Compatibility:
- Solution Compatibility: 0.9% NaCl ONLY
- Additives/Above Cassette Compatible: Do not mix with other drugs or IV solution
- Incompatible: Do not mix with other drugs or IV solutions
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | No |
| IM | No |
| IV Push | No |
| IV Intermittent Infusion |
Yes Usual dilution: in 100 mL of NS (Usual concentration: 1.4 - 16.5 mg/mL)
Infusion time: 90 minutes for initial dose 60 minutes for 2nd dose (if initial dose is well tolerated) 30 minutes for subsequent doses (if well tolerated) Flush infusion line with sodium chloride to ensure complete delivery Flush is not included in recommended infusion time |
| IV Continuous Infusion | No |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- 5 – 10 mg/kg every 14 days
- 7.5 mg/kg every 21 days
- Dosage may differ according to protocol. Refer to patient specific protocol.
- Different bevacizumab products are not interchangeable
Potential hazards of parenteral administration:
- Serious hypersensitivity reactions, including anaphylactic and anaphylactoid-type reactions (≤ 5%)
- Common: bleeding, fatigue, hypertension, proteinuria, headache, diarrhea, venous thromboembolism, nausea, vomiting and constipation.
- Occasional: asthenia, pain, epistaxis, upper respiratory tract infection, hematuria, myelosuppression
- Rare: gastrointestinal perforation/fistula, hemorrhage, arterial thromboembolism, nephrotic syndrome, congestive heart failure, wound healing complications, reversible posterior leukoencephalopathy syndrome, osteonecrosis of jaw, necrotising fasciitis (usually secondary to wound healing complications, GI perforation, or fistula formation), intraocular inflammation or hemorrhage, retinal detachment or tear
Notes:
- Decrease infusion rate for mild (clinically insignificant) infusion reaction; interrupt infusion for clinically significant infusion reaction (after symptoms resolve, resume at a decreased infusion rate); discontinue bevacizumab for severe infusion reaction
- Do not administer within 28 days following a major surgery, 14 days within intermediate surgery and within 7 days following a minor surgery. Bevacizumab should be suspended at least 28 days prior to elective surgery. Do not administer until the surgical wound is completely healed
- When given in combination with irinotecan, the metabolite concentrations or irinotecan may increase which may increase the risk of severe diarrhea and leukopenia
- An acute rise in blood pressure may occur during bevacizumab infusion. If this occurs, bevacizumab infusion should be stopped. Infusion may be resumed at a slower rate if blood pressure returns to pre-treatment range within one hour.
- Use with caution in patients with inherited or acquired coagulopathy.
- Hold Bevacizumab for two weeks if antithrombotic therapy must be initiated
- Contraindicated in patients with untreated central nervous system metastases
- Patients with active peptic ulcer disease should be treated with a proton pump inhibitor or H2 blocker while on Bevacizumab treatment
References:
- Avastin. Product Monograph. Hoffman La Roche. Version 14Jan2021
- Avastin. Cancer Care Ontario Monograph. Accessed 14Jan2021
- Avastin. Cancer Drug Manual. BC Cancer Agency. Accessed 14Jan2021
- BC Cancer Chemotherapy Preparation and Stability Chart version 2.00. BC Cancer Agency. Accessed 13Jan2021.
- Mvasi. Product Monograph. Amgen. Version 20Jan2021
- Zirabev. Product Monograph. Pfizer. Version 5Jan2021