Bevacizumab (Avastin)

• What bevacizumab is
• How you have treatment
• Common side effects
• Occasional side effects
• Rare side effects
• Important points to remember
• Immunisations and bevacizumab

Bevacizumab (pronounced bev-ah-siz-oo-mab) is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. It is also known by its brand name, Avastin. It is a treatment for

• advanced bowel cancer, given with chemotherapy.
• for metastatic breast cancer
• advanced non small cell lung cancer, given with chemotherapy
• kidney cancer.

You may also have it as part of a trial for other types of cancer.

Bevacizumab targets a protein on the cells called vascular endothelial growth factor (VEGF). This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. All cancers need a blood supply to be able to survive and grow. Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and won’t be able to grow. Doctors call treatments that interfere with the development of a blood supply anti-angiogenesis treatments.

You have bevacizumab through a drip into a vein. For advanced bowel cancer, you may have it every 2 weeks or every 3 weeks. You have the first dose over 90 minutes. If you don’t have any problems, the infusion time can gradually be reduced to 30 minutes. For metastatic breast cancer, you usually have it every 2 to 3 weeks. For lung cancer you usually have it every 3 weeks, and for kidney cancer every 2 weeks.

The side effects associated with bevacizumab are listed below. The effects may be different if you are having it with other drugs.

Bevacizumab may cause

• High blood pressure during treatment - affects about 1 in 4 people (25%). Your nurse or doctor will check this regularly. Your doctor may start you on blood pressure tablets, increase your dose if you are already on them, or stop bevacizumab until your blood pressure is under control
• Feeling sick - affects up to 2 out of 3 people (67%), but most people aren’t actually sick
• Constipation - affects up to 4 out of 10 people (40%)
• Diarrhoea - some reports say this can be severe in up to 1 in 3 people treated (32%)
• Fatigue - tiredness often carries on after treatment has ended. It can be the effect that most disrupts your daily life. But most people find their energy levels are back to normal after 6 months to a year
• Pain and weakness affecting your joints, muscles, chest and abdomen
• Numbness or tingling in fingers and toes affects more than 1 in 10 people (10%) and can cause difficulty with fiddly things such as doing up buttons. This may start within a few days or weeks and usually goes within a few months of finishing treatment
• Slow wound healing - you won’t start on bevacizumab until at least 28 days after surgery, or after any wounds have healed
• Protein in your urine - affects about 1 in 4 people (25%). You will have your urine tested regularly. If you have protein in your urine you will need to have a 24 hour urine collection to check your kidneys are working normally
• Increased risk of bleeding - your gums may bleed easily and you may have nose bleeds
• This drug may have a harmful effect on a baby developing in the womb. It is not advisable to become pregnant or father a child if you are having this drug and for 6 months after treatment. You should talk about contraception with your doctor before having the treatment
• Poor appetite

Some people have one or more of the following side effects

• A reaction to bevacizumab during infusion. This affects fewer than 3 in every 100 people treated (3%) , causing chills, fever and possibly an itchy rash, feeling sick, breathlessness, wheezing, a headache, flushes and faintness
• Drop in white blood cell count causing an increased risk of bacterial infection. Infection may cause headaches, aching muscles, a cough, sore throat, pain when passing urine, or may make you feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact your treatment centre if you think you have an infection
• Blood clots - if this happens, you will have treatment to thin your blood, dissolve any blood clots and stop more clots developing
• Heart problems - affects fewer than 2 out of 100 people treated (2%), causing chest pain, swollen ankles, breathlessness and a fast heart rate. Tell your doctor or nurse if you have any of these symptoms
• A split in the wall of the bowel (bowel perforation) - affects fewer than 2 in every 100 people treated (2%), but is a serious side effect if it happens

A very small number of people may have one or more of the following side effects. If you have any of these symptoms it is important to tell your doctor.

• Headaches, seizures (fits), changes in eye sight, excessive sleepiness, change in behaviour, possibly high blood pressure - doctors call this group of symptoms Reversible Posterior Leucoencephalopathy Syndrome (RPLS)
• Very high blood pressure (hypertensive encephalopathy). It can occur with other symptoms such as a headache, feeling sick, sleepiness, and confusion

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You should have a contact number for your chemotherapy nurse, clinic or ward nurse. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.