What is bevacizumab (Avastin®)?

Bevacizumab (Avastin®) is a targeted therapy drug used to treat different types of cancer. It may be called a monoclonal antibody or angiogenesis inhibitor.

Bevacizumab targets a protein called vascular endothelial growth factor (VEGF) that helps cancer cells grow a new blood supply. Targeting VEGF reduces the supply of oxygen and nutrients so that the tumour shrinks or stops growing.

It is best to read this information with our general information about the type of cancer you have.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

Bevacizumab may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may have it as part of a clinical trial.

If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment is not available.

How bevacizumab is given

You will be given bevacizumab at a day unit as an outpatient. Bevacizumab can be given in combination with other cancer drugs.

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. Your nurse will tell you when your treatment is likely to be ready.

Bevacizumab can be given through:

  • a short thin tube the nurse puts into a vein in your arm or hand (cannula)
  • a fine tube that goes under the skin of your chest and into a vein close by (central line)
  • a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).

Your course of treatment

You usually have a course of several cycles of treatment over a few months. Bevacizumab is usually given once every 2 or 3 weeks, depending on the type of cancer you have. You have the first treatment slowly over 90 minutes. If you do not have any problems, you have the next treatment over 60 minutes. After this, you usually have it over 30 minutes.

Your nurse, pharmacist or doctor will discuss your treatment plan with you.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Side effects while treatment is being given

Some people may have side effects while they are being given the treatment or shortly after they have it:

Allergic reaction

Some people may have a reaction to bevacizumab. This is rare and if it happens it is usually mild. A reaction is more likely to happen with the first or second infusion, so you have these more slowly.

Signs of a reaction include:

  • feeling hot or flushed
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless
  • swelling of your face or mouth
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs tell them straight away. A reaction can usually be treated by stopping the drip until you feel better.

Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection.

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. 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. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Bleeding

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.

Contact your doctor straight away if you have any unusual bleeding. This includes:

  • vomiting or coughing up blood
  • unexpected vaginal bleeding
  • blood in your poo (stools).

Increased blood pressure

This treatment can cause high blood pressure. You will have your blood pressure checked regularly. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.

If you have high blood pressure before you start treatment, your doctor will monitor you closely during treatment.

Feeling sick

You may feel sick in the first few days after treatment. If you feel sick, tell your doctor. They can prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Effects on the kidneys

Bevacizumab can sometimes affect the kidneys. You may have urine and blood tests to check how well your kidneys are working.

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 (peripheral neuropathy)

This treatment affects the nerves. This can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Eye problems

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.

Voice changes

You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.

Less common side effects

Blood clots

Bevacizumab can increase the chance of a blood clot (thrombosis). A clot can cause:

  • pain, redness and swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact your doctor straight away. 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 about this.

A blood clot can increase the risk of having a stroke. Signs of a stroke include:

  • weakness or numbness in one side of your body
  • slurred speech or drooping of your face, mouth or eye.

If you, or someone you know, notices you have any of these symptoms, contact a doctor straight away.

Slow wound healing

Wounds may take longer to heal while you are 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.

Skin changes

Bevacizumab may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Changes in the way your heart works

This is rare. It is most likely to affect people who have heart disease or who have had radiation to the chest or some types of chemotherapy drugs.

Tell your doctor straight away if:

  • you feel that your heart is beating too fast
  • you have chest pain or difficulty breathing
  • you have ankle swelling.

These could be signs that bevacizumab is affecting your heart.

Pain in the tummy (abdomen)

Bevacizumab can cause a hole (perforation) in the bowel but this is not common. It is more likely if you have also had radiotherapy to the pelvis (lower part of the tummy). Tell your doctor straight away if you have sudden or severe pain in your tummy.

Bevacizumab can sometimes cause your bowel to become blocked (bowel obstruction). Tell your doctor straight away if you stop passing poo and have severe pain in your tummy.

Fistula

Very rarely, bevacizumab can cause a fistula. A fistula is an abnormal opening that connects two or more parts of the body. If this happens, it is more likely in the part of the body affected by the cancer.

Jaw problems (osteonecrosis)

Rarely, bevacizumab may cause osteonecrosis of the jaw. This is when bone tissue in the jaw becomes damaged and dies. Symptoms of osteonecrosis include:

  • pain
  • swelling
  • redness of the gums
  • loose teeth.

Tell your cancer specialist and dentist straight away if you have any of these symptoms.

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 will be advised to have a full dental check-up.

It is important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.

Other information

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Fertility

This treatment can affect if you can get pregnant or make someone pregnant.

If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start treatment.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for at least 6 months afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

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