Bevacizumab (Avastin®)

Research trials are looking at how effective Avastin® is in treating other types of cancer, such as kidney cancer| , and early breast and bowel cancer.

What is Avastin? Back to top

Avastin is one of a new group of cancer drugs known as monoclonal antibodies. It's usually given alongside chemotherapy| . Avastin is mostly given to people who have advanced bowel cancer (cancer that has spread to other parts of the body), advanced breast cancer| and advanced non-small cell lung cancer .

Although Avastin is licensed and can be prescribed in the UK, it has not been approved for use by the National Institute for Health and Clinical Excellence (NICE). NICE gives advice on which new drugs or treatments should be available on the NHS. As a result, Avastin may not be widely available on the NHS.

For more information see our section on what you can do if a treatment isn't available| .

Monoclonal antibodies Back to top

Monoclonal antibodies|  can destroy some types of cancer cells while causing little harm to normal cells. They do this by recognising certain proteins that are found on the surface of some types of cancer cells (known as receptors) and 'locking' themselves onto them.

There are different types of antibodies that work in different ways. Once the monoclonal antibody has attached to the receptor it can:

• trigger the body’s immune system to attack the cancer cells and cause the cells to destroy themselves, or
• block the receptor from connecting with a different protein that helps the cell to grow. This may stop the cells from growing and dividing, or prevent the cancer cells from developing a new blood supply.

How Avastin works Back to top

Avastin can stop some cancers from developing new blood vessels. This reduces the cancer’s supply of oxygen and nutrients, which causes the tumour to shrink, or at least to stop growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.

What it looks like Back to top

Avastin is a colourless fluid.

How it is given Back to top

Avastin is given through a small tube (cannula) inserted into a vein. It may be given in combination with chemotherapy drugs.

Some people are given their Avastin and chemotherapy through a fine plastic tube which is inserted under the skin into a vein near the collarbone (central line| ), or passed through a vein in their arm (PICC line| ). Your doctor or nurse will explain more about this to you.

Possible side effects Back to top

Each person’s reaction to cancer treatment is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given Avastin. The drug is often used in combination with chemotherapy, so patients will also have side effects from the chemotherapy. The side effects mentioned below are those caused by Avastin.

We have outlined the most common side effects, but have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed below, please discuss them with your doctor or nurse.

Tiredness and a general feeling of weakness You may feel very tired| . It is important to allow yourself plenty of time to rest.

Feeling sick (nausea) and being sick (vomiting) If this happens, it may begin a few hours after the treatment is given and last for up to a few days. Your doctor can prescribe very effective anti-sickness (antiemetic) drugs to prevent or greatly reduce nausea and vomiting| . If the sickness is not controlled, or if it continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea| .

Allergic reactions It is common to have a slight allergic reaction to Avastin, but some people have a more severe reaction. Signs of a reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness| . You will be monitored closely during your treatment, but it is very important to tell your nurse or doctor if you have any of these symptoms.

High blood pressure and circulatory problems You may be at increased risk of developing circulatory problems such as a stroke and angina (heart pain) while taking Avastin. Your blood pressure will be checked regularly during your treatment. If you have headaches, nosebleeds or feelings of dizziness let your doctor know.
 
Blood clots You may be at increased risk of developing a blood clot (in your veins or arteries) while you are on Avastin®. If this happens, you will have treatment to thin your blood, dissolve any blood clots and stop more clots developing. Let your doctor know if you or anyone in your family has had problems with blood clotting in the past.

Slow wound healing Wounds may take longer to heal while you are having treatment with Avastin.

Constipation Let your doctor know if you develop constipation| . This can often be relieved with a high-fibre diet or laxatives. Bruising or bleeding Avastin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.

Changes in the way your heart works Symptoms of this will include chest pain, difficulty breathing, and swelling of the ankles (because of water retention). Let your doctor know if you develop any of these symptoms.

Lowered resistance to infection Avastin® can reduce the production of white blood cells by the bone marrow, making you more prone to infection| . Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.4ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test during your treatment to make sure that your blood cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.

Damage to the kidneys Avastin can sometimes temporarily change the way that your kidneys work. You may have blood tests to check that your kidneys are working well.

Less common side effects Back to top

Headaches Let your doctor know if you have headaches while you are having Avastin treatment.

Sore mouth and taste change Your mouth may become sore| , or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening.

Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Loss of appetite You may find that you do not feel like eating. A dietitian or specialist nurse at the hospital can give advice on boosting your appetite and eating well| .

Pain in the area of the tumour Some people may have pain| in the area of the tumour.
 
If you have any questions about these or any other side effects talk to your doctor or nurse. It is important to let them know if you have any symptoms or side effects that you think may be related to any treatment you are having.

Additional information Back to top

Some other medicines can be harmful to take when you are having Avastin. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

In some people with lung cancer there is a risk of bleeding into the lung tissue. If people have already coughed up blood they should not have treatment with Avastin.

Contraception

It is not advisable to become pregnant or father a child while taking Avastin as not enough is known about its effect on the developing foetus. It is important to use effective contraception during your treatment and for a year afterwards. You can discuss this with your doctor or specialist nurse.

References Back to top

This information has been compiled using information from a number of reliable sources, including:

• Sweetman et al. Martindale: The Complete Drug Reference. 36th edition. 2009. Pharmaceutical Press.

• Bevacizumab and Cetuximab for the Treatment of Metastatic Colorectal Cancer. 2007. National Institute for Health and Clinical Excellence (NICE).

• British National Formulary. 58th edition. 2009. British Medical Association and Royal Pharmaceutical Society of Great Britain.

• Risk of Venous Thromboembolism with the Angiogenesis Inhibitor Bevacizumab in Cancer Patients. Journal of the American Medical Association. 2008

For further references, please see the general bibliography| .