II. Indications
-
Colorectal Cancer (metastatic, advanced or unresectable)
- Bevacizumab
- Ramucirumab
-
Non-Small Cell Lung Cancer
- Bevacizumab
- Ramucirumab
- Glioblastoma (recurrent)
- Bevacizumab
-
Renal Cell Carcinoma (metastatic)
- Bevacizumab
-
Cervical Cancer (advanced, recurrent)
- Bevacizumab
-
Ovarian Cancer, Fallopian Tube Cancer or Primary Peritoneal Cancer (resistant)
- Bevacizumab
-
Hepatocellular Carcinoma
- Bevacizumab
- Ramucirumab
-
Gastric Cancer (advanced)
- Ramucirumab
- Soft-Tissue Sarcoma
- Bevacizumab (off-label)
-
Age-Related Macular Degeneration
- See VEGF Inhibitor Intravitreal Injection
- Bevacizumab (off-label)
III. Mechanism
-
Vascular Endothelial Growth Factor Receptor (VEGF, VEGFR)
- See Tyrosine Kinase
- Angiogenesis signaling Protein
- Vascular Endothelial Growth Factors (VEGF) are pro-angiogenic Cytokines
- Bind to VEGF receptors on Tyrosine Kinases to initiate Angiogenesis
- Target in some Targeted Cancer Therapy (as below)
- Other functions
- Monocyte activation and differentiation (VEGFR 1)
- Also used in Age-Related Macular Degeneration as a VEGF Inhibitor Intravitreal Injection
-
VEGFR Inhibitors
- VEGF Inhibitors suppress Angiogenesis
- Recombinant Monoclonal Antibody against Vascular Endothelial Growth Factor (VEGF)
- Inhibit VEGF receptor binding, interfering with the growth and maintenance of neoplastic vessels
- Other Inhibitors of VEGFR
IV. Medications
- Bevacizumab (Avastin) IV Infusion
- Risk of CV events, VTE, bleeding, MAHA, GI perforation, Proteinuria, Hypertension, poor Wound Healing
- Ramucirumab (Cyramza) IV Infusion
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
-
General
- Infusion Reaction (Bevacizumab, Ramucirumab)
- Poor Wound Healing and wound dehiscence (Bevacizumab, Ramucirumab)
- Avoid Bevacizumab for 28 days before elective surgery and at least 28 days after surgery
- Cardiovascular
- Arterial Thrombosis including TIA/CVA, MI (Bevacizumab, Ramucirumab)
- Severe Hypertension including PRES (Bevacizumab, Ramucirumab)
- Congestive Heart Failure (Bevacizumab)
- Hematologic
- Venous Thromboembolism (Bevacizumab)
- Microangiopathic Hemolytic Anemia or MAHA (Bevacizumab, Ramucirumab)
- Hemorrhage (Bevacizumab, Ramucirumab)
- Gastrointestinal
- Gastrointestinal perforation or fistula (Bevacizumab, Ramucirumab)
- Exacerbation of hepatic Impairment in patients with cirrhosis Child-Pugh B or C (Ramucirumab)
- Renal
- Proteinuria including Nephrotic Syndrome (Bevacizumab, Ramucirumab)
- Endocrine
- Premature Ovarian Failure with Impaired future fertility (Bevacizumab)
- Thyroid dysfunction (Ramucirumab)
- Other common reported adverse effects
VII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters, Pregnancy category X)
- Use reliable Contraception
- Monitoring
- Blood Pressure
- Urinalysis
- Thyroid Function Tests (Ramucirumab)
VIII. Drug Interactions
-
Anticoagulation
- Higher risk of bleeding and thrombosis while on Venous Thromboembolism treatment (Bevacizumab)
-
Sunitinib
- Avoid in combination with Bevacizumab
IX. Resources
Images: Related links to external sites (from Bing)
Related Studies
Definition (CHV) | a kind of cancer treatment drug |
Definition (CHV) | a kind of cancer treatment drug |
Definition (NCI_NCI-GLOSS) | A drug used to treat several types of cancer, including certain types of colorectal, lung, breast, and kidney cancers and glioblastoma. It is also being studied in the treatment of other types of cancer. Avastin binds to vascular endothelial growth factor (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. It is a type of antiangiogenesis agent and a type of monoclonal antibody. |
Definition (NCI) | A recombinant humanized monoclonal antibody directed against the vascular endothelial growth factor (VEGF), a pro-angiogenic cytokine. Bevacizumab binds to VEGF and inhibits VEGF receptor binding, thereby preventing the growth and maintenance of tumor blood vessels. |
Definition (NCI) | A monoclonal antibody directed against human Vascular Endothelial Growth Factor (VEGF), a protein that stimulates angiogenesis, and prevents VEGF from binding to its receptors, causing inhibition of angiogenesis. (NCI) |
Definition (PDQ) | A recombinant humanized monoclonal antibody directed against the vascular endothelial growth factor (VEGF), a pro-angiogenic cytokine. Bevacizumab binds to VEGF and inhibits VEGF receptor binding, thereby preventing the growth and maintenance of tumor blood vessels. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43234&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43234&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C2039" NCI Thesaurus) |
Concepts | Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) , Pharmacologic Substance (T121) |
MSH | C469428 |
SnomedCT | 409405006, 409406007 |
English | BEVACIZUMAB @ @ UNIDENTIFIED, BEVACIZUMAB UNIDENTIFIED, Anti-VEGF Humanized Monoclonal Antibody, Anti-VEGF RhuMAb, Recombinant Humanized Anti-VEGF Monoclonal Antibody, Recombinant Humanized Monoclonal Antibody to Vascular Endothelial Growth Factor, Anti-VEGF, bevacizumab (medication), Monoclonal Antibody Anti-VEGF, Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer, Anti-VEGF rhuMAb, rhuMab-VEGF, Anti-VEGF Monoclonal Antibody, bevacizumab [Chemical/Ingredient], rhumab vegf, bevacizumab, Bevacizumab Biosimilar BEVZ92, anti-VEGF monoclonal antibody, rhuMAb VEGF, Bevacizumab, Bevacizumab (product), Bevacizumab (substance), MoAb VEGF, BEVACIZUMAB |
Spanish | bevacizumab (producto), bevacizumab (sustancia), bevacizumab |