How does it work?
Avastin infusion contains the active ingredient bevacizumab, which is a type of medicine called a humanised monoclonal antibody. It is used to treat cancers of the large intestine and rectum (colorectal cancers) and breast cancers that have spread to other parts of the body. It can also be used to treat advanced lung cancer and advanced kidney cancer.
In order to grow, cancerous tumours need a blood supply that provides the cancer cells with nutrients and oxygen. The growth of the cancer therefore depends on the tumour having a network of blood vessels supplying it.
Cancerous tumours produce substances called growth factors that stimulate nearby blood vessels to grow into the tumour. These new blood vessels allow the cancer cells to grow and multiply and also allow them to spread into other areas of the body through the blood circulation.
Tumours have been found to produce a particular growth factor called vascular endothelial growth factor (VEGF). VEGF stimulates new blood vessels to grow into the tumour.
Bevacizumab acts by neutralising this VEGF. It works in a similar way to the natural antibodies produced by our immune system. Our natural antibodies recognise foreign invaders and bind to them, helping our immune systems to attack them and protect us from infections. Monoclonal antibodies like bevacizumab are made in laboratories and can be used to attack particular proteins in a similar way.
Bevacizumab specifically recognises and binds to the VEGF produced by the tumour. This makes the VEGF unable to stimulate blood vessels to grow. As a result, the cancer’s blood supply is reduced and with it, its supply of oxygen and nutrients. This causes the tumour to shrink, or at least to stop growing.
Medicines that stop the growth of blood vessels in this way are called angiogenesis inhibitors.
As bevacizumab is targeted specifically against the VEGF protein produced by the tumour, it has little effect on healthy cells or existing blood vessels elsewhere in the body.
Bevacizumab is given in combination with chemotherapy treatment that directly attacks and kills the cancer cells. To treat colorectal cancer it can be given with fluoropyrimidine-based chemotherapy such as 5FU (fluorouracil) and folinic acid, irinotecan, capecitabine or oxaliplatin. To treat breast cancer it is given in combination with paclitaxel or capecitabine. To treat lung cancer it is given in combination with platinum-based chemotherapy. To treat kidney cancer it is given in combination with interferon alfa-2a. To treat ovarian cancer it is given in combination with carboplatin and either paclitaxel or gemcitabine.
What is it used for?
- Cancer of the large bowel (colon) and rectum (colorectal cancer) that has spread to other areas of the body.
- Breast cancer that has spread to other areas of the body.
- Advanced non-small cell lung cancer (NSCLC).
- Advanced kidney cancer and/or kidney cancer that has spread to other areas of the body.
- Advanced ovarian, fallopian tube or primary peritoneal cancer.
How is this treatment given?
Bevacizumab is given as a drip into a vein (intravenous infusion) once every two or three weeks. The first dose is administered over 90 minutes. If this is well tolerated, the next dose may be given over 60 minutes; if this is also well tolerated all further doses may be given over 30 minutes.
- This medicine may interfere with the wound healing process because it impairs the growth of new blood vessels. For this reason, treatment with this medicine should not be started until at least 28 days after major surgery, or until any wound from surgery is fully healed. If you need to have any operations, treatment with this medicine will need to be interrupted.
- Your doctor will need to regularly check your blood pressure and levels of protein in your urine while you are having treatment with this medicine.
- This medicine may decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you may need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
- There may be an increased risk of developing a blood clot in a vein (DVT or pulmonary embolism) or a blood clot in an artery (which could cause a heart attack or stroke) while having treatment with this medicine. For this reason, you should let your doctor know immediately if you get any of the following symptoms during treatment: stabbing pains and/or unusual swelling in one leg, pain on breathing or coughing, coughing up blood, sudden breathlessness, sudden severe chest pain, sudden disturbance in vision, hearing or speech, sudden weakness or numbness on one side of the body, fainting or collapse.
- Tell your doctor immediately if you experience seizures (fits), headache, confusion or changes in vision during treatment with this medicine.
- This medicine has been associated with a rare condition called osteonecrosis of the jaw. The majority of cases have occured in people who have also had treatment with medicines called bisphosphonates by injection into a vein. Osteonecrosis of the jaw is a known risk of bisphosphonates. The risk of this condition may also be increased by poor oral hygiene, dental problems such as gum disease or poorly fitting dentures, teeth extractions, oral surgery and smoking. For this reason, you should have a dental examination and, if necessary, appropriate preventive dentistry, before you start treatment with this medicine. Discuss this with your doctor. It is important to look after your mouth and teeth as much as possible while you are taking this medicine. You should have regular check-ups with your dentist and get advice straight away if you have any problems with your mouth or teeth. When you see a dentist during treatment, make sure they know you are having treatment with this medicine. Invasive dental procedures such as tooth extraction or surgery should be avoided if possible, particularly if you are also having treatment with a bisphosphonate.
- This medicine may affect your ability to get pregnant. It is important to discuss fertility with your doctor before treatment with this medicine is started.
- This medicine may also be harmful to an unborn baby. For this reason, women receiving this medicine should use an effective method of contraception to prevent pregnancy, both during treatment and for at least six months after treatment is finished. You should consult your doctor immediately if you get pregnant.
Use with caution in
- People over 65 years of age.
- People with inflammation in the gut or abdomen (eg diverticulitis, stomach ulcers, bowel inflammation (colitis) associated with chemotherapy).
- People with uncontrolled high blood pressure (hypertension) or a history of high blood pressure.
- People who have ever had a heart attack, stroke or mini-stroke (transient ischaemic attack).
- Heart failure.
- People who have previously been treated with radiotherapy to the chest or with anthracycline chemotherapy medicines such as doxorubicin.
- People with tumours that have spread to the brain or spinal cord (central nervous system) and have not been treated.
- People with blood clotting problems.
- People having treatment with anticoagulant medicines for a blood clot.
- People who have recently had major surgery or any major wounds.
Not to be used in
- Allergy to Chinese hamster ovary (CHO) cell products or other recombinant human or humanised antibodies.
- People who have recently had any bleeding in the lungs or who have been coughing up blood.
- The safety and efficacy of this medicine have not been established in children and adolescents under 18 years of age. It is not recommended for this age group.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine must not be used during pregnancy. It could be harmful to a developing foetus because it stops the formation of new blood vessels. Women who could get pregnant must use effective methods of contraception to prevent pregnancy while having treatment with this medicine and for at least six months after the treatment is finished. Seek medical advice from your doctor. Inform your doctor immediately if you think you could be pregnant at any point during treatment.
- It is not known if this medicine passes into breast milk. However, as it could harm the development of the infant if it does pass into breast milk; mothers should not breastfeed during treatment with this medicine, and for at least six months after their last dose. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Raised blood pressure (hypertension).
- Abdominal pain.
- Feeling weak or tired.
- Decreased number of white blood cells, red blood cells or platelets in the blood (see warning section above).
- Feeling of numbness or tingling in hands or feet.
- Slow wound healing.
- Nausea and vomiting.
- Aching muscles or joints.
- Watery eyes.
- Sore mouth.
- Loss of appetite.
- Change in taste.
- Shortness of breath.
- Blood clot in a vein of the leg or in the lungs (deep vein thrombosis or pulmonary embolism) - see warning section above.
- Blood clot in an artery, causing a heart attack or stroke - see warning section above.
- Heart failure.
- Formation of holes (perforation) in the wall of the stomach or intestine.
- Formation of abnormal tube-like connections between organs that are not normally connected or between an organ and the skin (fistulae).
- Protein in the urine, which may be linked to kidney problems.
- Skin reactions such as dry or peeling skin, skin discolouration or hand-foot reaction.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
You should tell your doctor or pharmacist if you are taking any other medicines, including those bought without a prescription and herbal medicines, before you start treatment with Avastin. Similarly, you should also check with your doctor or pharmacist before taking any new medicines while you are still receiving treatment with Avastin, so they can check that the combination is safe.
People who have had treatment with an anthracycline chemotherapy medicine, such as doxorubicin, epirubicin or idarubicin, before starting treatment with this medicine may have a higher risk of side effects on the heart.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain bevacizumab as the active ingredient.