Bevacizumab (Avastin ®)
Bevacizumab (Avastin ®) is a targeted therapy being developed to treat many cancers. It is being tested in research trials.
Monoclonal antibodies are sometimes called targeted therapies. They work by ‘targeting’ specific proteins on the surface of cancer cells. Bevacizumab targets a protein called vascular endothelial growth factor (VEGF) that helps cancer cells develop a new blood supply.
Targeting VEGF reduces the supply of oxygen and nutrients so that the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth are called anti-angiogenics.
When bevacizumab is used
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The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs on the NHS in Scotland. Neither NICE nor the SMC has recommended the use of bevacizumab. Some people may be given it as part of a clinical trial.
Bevacizumab is not routinely available on the NHS. If you live in Northern Ireland, your cancer specialist can explain whether bevacizumab may be available to you.
Some people may be able to have bevacizumab as a treatment by applying to the Cancer Drugs Fund (England only) or their local health body.
How bevacizumab is given
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You may have bevacizumab in combination with chemotherapy drugs. It may be given with interferon when it is used to treat kidney cancer. A nurse will give you bevacizumab as a drip into a vein (intravenous infusion). It's usually given once every two or three weeks, depending on the type of cancer you have.
You have the first treatment given slowly over 90 minutes. If you don’t have any problems, such as a reaction, you can have your next drip over 60 minutes. After this, you can usually have the treatment over 30 minutes.
Some people may have a reaction to bevacizumab. This isn’t common and, if it happens, it is usually mild.
A reaction is more likely with the first or second infusion so you‘ll have them more slowly.
Your nurse will closely monitor you while you are having the treatment. But tell your nurse or doctor if you feel unwell or have any of the following: fever, chills, or dizziness; a rash; swollen lips, tongue or throat; feeling breathless or wheezy; pain in the chest, back or stomach.
A reaction can usually be treated by stopping the drip until you feel better. Rarely, a reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Possible side effects of bevacizumab
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Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. Bevacizumab is often used in combination with chemotherapy, so you may also have side effects from the chemotherapy. The side effects mentioned here are those caused by bevacizumab.
We explain the most common side effects of bevacizumab here. But we don’t include all the less common ones that are unlikely to affect you. Always tell your doctor, nurse or pharmacist about the side effects you have. They can prescribe drugs to help control them and give you advice about managing them.
High blood pressure
Bevacizumab can cause an increase in blood pressure. Your blood pressure will be checked regularly during your treatment. If you have headaches or nosebleeds or feel dizzy, let your doctor know. High blood pressure can usually be controlled with tablets prescribed by your doctor.
This may happen a few hours after treatment and can last for a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or control sickness.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
You may feel tired during and after your treatment. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Diarrhoea or constipation
This can usually be controlled with medicine, but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Drinking at least 2 litres of fluids (3.5 pints) every day will help with constipation. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
Some people find that bevacizumab causes headaches. Let your doctor or nurse know as they can give you painkillers to relieve this.
Sore mouth and ulcers
Your mouth may become sore or dry, or you may get small ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might advise you to use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Loss of appetite
Some people lose their appetite. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Changes in how your kidneys work
Bevacizumab can sometimes affect the kidneys. You may have tests done on samples of your urine and blood to check that your kidneys are working well.
Effect on blood cells
Bevacizumab can reduce the number of white and red blood cells in your blood. You will have regular blood tests to check the numbers of blood cells. Occasionally, it may be necessary to delay your treatment until these levels recover.
Risk of infection
If you have a low number of white blood cells you are more likely to get an infection. If this happens during your treatment your doctor or nurse will advise you how to reduce your risk of infection.
Contact the hospital straight away if:
your temperature goes over 37.5°C (99.5° F) or over 38°C (100.4° F), depending on the advice given by your healthcare team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Anaemia (low number of red blood cells)
If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
Bevacizumab can sometimes cause bleeding problems, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Tell your doctor if you are taking any medicines that may affect bleeding. This includes aspirin, blood-thinning tablets such as warfarin, or injections such as heparin, or vitamin E.
Contact your doctor right away if you have any unusual bleeding including vomiting or coughing up blood, unexpected vaginal bleeding or blood in your stools (bowel movements).
Joint and muscle pain
You may have pain and stiffness in your joints, and sometimes in your muscles. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice.
Numb or tingling hands or feet
You may find it hard to fasten buttons or do other fiddly tasks. This is called peripheral neuropathy. The symptoms usually improve slowly after treatment finishes. Talk to your doctor if you are worried about this.
Your eyes may become watery. Your doctor can prescribe eye drops to help with this. Always tell your doctor or nurse if you notice any changes in your vision.
You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.
Less common side effects of bevacizumab
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Bevacizumab can increase the chance of a blood clot (thrombosis). A clot can cause pain, redness and swelling in a leg, breathlessness or chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Slow wound healing
Wounds may take longer to heal while you're being treated with bevacizumab. If you have any wounds which are not healing or look infected, speak to your doctor straight away.
If you have any surgery planned, bevacizumab will be stopped about four weeks before the operation and not started again until the wound is fully healed.
Changes in the way your heart works
This is rare. It's most likely to affect people who have heart disease or who have had radiation to the chest or certain chemotherapy drugs such as doxorubicin or epirubicin. Let your doctor know if you have chest pain, difficulty breathing or ankle swelling as these could be signs that bevacizumab is affecting your heart.
Pain in the tummy (abdomen)
Bevacizumab can cause a hole (perforation) in the small bowel but this isn’t common. Tell your doctor immediately if you have sudden or severe pain in your tummy (abdomen).
Very rarely, bevacizumab can cause a fistula. This is a tunnel-like connection between two parts of the body not usually connected. If you notice any changes in your bowel or bladder habits or any vaginal changes, tell your doctor straight away.
Jaw problems (osteonecrosis)
A rare side effect is a condition called osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. Gum disease, problems with your dentures and some dental treatments, such as having a tooth removed, can increase the risk of this. Before you start taking the drug you'll be advised to have a full dental check-up.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about bevacizumab
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having bevacizumab. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your doctor will advise you not to become pregnant or father a child during treatment or for at least six months after. Bevacizumab can harm a developing baby.
There is a possible risk that bevacizumab may be present in breast milk, so women are advised not to breastfeed during this treatment and for at least six months afterwards.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having bevacizumab. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having bevacizumab.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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