Bevacizumab can be used to treat people with cancer of the colon, breast, or kidneys, as well as people with non-small cell lung cancer. It can also be used to treat other types of cancer as part of a research trial.
WHAT IS BEVACIZUMAB?
Bevacizumab belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies because they work by targeting specific proteins on the surface of cells.
HOW DOES BEVACIZUMAB WORK?
Bevacizumab targets a protein called vascular endothelial growth factor. This is a protein that helps cancer cells develop a new supply of blood. Bevacizumab blocks the protein and stops new blood vessels from developing. This reduces the supply of oxygen and nutrients to the cancer, making the tumor shrink or stop growing. Drugs that interfere with the growth of blood vessels are called angiogenesis inhibitors or anti-angiogenics.
WHAT DOES BEVACIZUMAB LOOK LIKE?
Bevacizumab is a colorless liquid.
HOW IS BEVACIZUMAB ADMINISTERED?
Bevacizumab can be given in combination with chemotherapy or interferon to treat kidney cancer.
Bevacizumab is given as a drip into a vein (intravenous infusion). It is normally given once every two or three weeks, depending on the type of cancer the patient has. The first infusion is given slowly over 90 minutes. If you don't have a reaction to the infusion, the second will be given in 60 minutes. After this, all the remaining infusions normally take 30 minutes, as long as you haven't had any reactions.
Bevacizumab is usually given for as long as it keeps the cancer under control, or until the side effects become too much to withstand.
POSSIBLE SIDE EFFECTS OF BEVACIZUMAB
Each person reacts differently to cancer treatment. Some people have very few side effects, while others may develop more. The side effects described here will not affect everyone who is treated with bevacizumab.
Bevacizumab is often used in combination with chemotherapy, which is why patients may have side effects brought on by chemotherapy itself. The side effects mentioned here are caused by bevacizumab.
We outline the most commonly side effects, though we have left out the rarer ones. If you notice you develop any side effects that are not listed here, talk to your doctor or nurse.
The side effects of bevacizumab are divided into two groups:
- Infusion-related reactions, which means that side effects that can happen during the infusion or up to 24 hours afterward.
- Other side effects that can happen days or even weeks later.
- Infusion-related reactions
These are not common, and affect less than 5% of people who take bevacizumab. If reactions do happen, they are normally mild, though in rare cases they can be severe.
It is more likely that reactions will occur on the first or second infusion; this is the reason why these initial infusions are given more slowly, as doing so lowers the likelihood of a reaction. If you have a reaction, the drip is usually lowered until you feel better.
You will be closely monitored during your treatment, though you should tell your nurse or doctor if you feel unwell or have any of the following symptoms:
- flu-like symptoms, such as fever, shivering, or nausea
- red, warm, and itchy bumps on the skin (such as urticaria)
- a feeling of swelling in the lips, tongue, or throat
- difficulty breathing, wheezing, and cough
- back or stomach pain
- chest pain or tightness of the chest.
Rarely, a reaction related to the infusion can happen a couple of hours after the treatment. If you develop these symptoms or feel unwell after you get home, get in touch with your hospital immediately for advice.
OTHER SIDE EFFECTS OF BEVACIZUMAB
NAUSEA AND VOMITING
This may begin a few hours after the treatment is given, and continue for a couple of days afterward. Your doctor can prescribe antiemetic drugs, which can prevent or substantially reduce your nausea and vomiting.
If your nausea remains uncontrolled or continues, tell your doctor, as they can prescribe other drugs that could work better. Some antiemetic drugs can cause constipation. Tell your doctor or nurse if this is a problem.
TIREDNESS (FATIGUE) AND FEELING OF WEAKNESS
You may feel tired during and after the treatment. It is important that you try to pace yourself and rest as much as you need to. Try to balance this with light exercise, such as taking short walks. If your tiredness leaves you feeling drowsy, do not operate machinery or drive.
Bevacizumab can cause diarrhea. Normally, this can be easily controlled with drugs, so tell your doctor if your diarrhea is severe or ongoing. It's important to drink lots of fluids if you have diarrhea.
HIGH BLOOD PRESSURE
Bevacizumab may cause increased blood pressure in some people. You will have your blood pressure checked regularly during your treatment. Tell your doctor if you have headaches, nosebleeds, or feel nauseous. High blood pressure can be controlled with drugs prescribed by your doctor.
Some people find that bevacizumab gives them headaches. Let your doctor or nurse know, as they can give you painkillers to relieve this.
SORENESS OF THE MOUTH AND MOUTH ULCERS
You may have a sore mouth or mouth ulcers. Some find that sucking on ice can be soothing. Drinking lots of fluids and regularly brushing your teeth gently using a soft-bristled toothbrush can help lower the risk of this happening. Tell your doctor or nurse if you have any of these problems, as they can prescribe a mouthwash and drugs to prevent infection in the mouth.
LOSS OF APPETITE
Some people lose their appetite while taking bevacizumab. This can be mild and last for a few days. If it doesn't get better, request to see a dietitian or specialist nurse at your hospital. They can give you advice on how to improve your appetite and maintain a healthy weight.
While you are taking bevacizumab, you may have an increased risk of developing blood clots in your veins or arteries. Tell your doctor if you or anyone in your family has had problems with blood clots in the past. Possible symptoms of blood clots include:
- chest pain
- feeling out of breath or dizzy
- changes in vision
- difficulty speaking or moving
- swelling, pain, redness, or a feeling of warmth in an arm or leg.
Get in touch with your doctor immediately if you have any of these symptoms, as you may require urgent treatment. Blood clots are treated with drugs to thin the blood, dissolve blood clots, and stop more clots from developing.
SLOW WOUND HEALING
Wounds may take longer to heal if you are being treated with bevacizumab. If you have any surgical operations scheduled, you should stop taking bevacizumab for four weeks before the operation and not resume taking the drug for up to four weeks afterward, or as long as the wound takes to heal fully.
In general, it may help to drink lots of fluids, eat more fiber, and get some light exercise. You may need to take drugs (laxatives) to help.
Bevacizumab may cause problems with bleeding. Tell your doctor if you are taking drugs that can affect coagulation, such as aspirin, warfarin, or vitamin E.
Get in touch with your doctor immediately if:
you cough up blood
you have unusual bruises, nosebleeds, or bleeding gums
you have unexplained vaginal bleeding
you vomit blood or vomit a liquid that is the color of ground coffee
you have black, tarry stool.
RISK OF INFECTION
Bevacizumab can reduce your number of white blood cells, which help fight off infection. White blood cells are produced by bone marrow. If your white blood cell count is low, you will be more prone to infection. A low number of white blood cells is called neutropenia. You will have a blood test before each treatment to make sure that your number of white blood cells has returned to normal.
Contact your doctor or your hospital immediately if:
- your temperature rises above 38 ° C
- you suddenly feel unwell, even if your temperature is normal.
- Occasionally, it may be necessary to stop giving you the drug if your white blood cell count is low.
CHANGES IN THE HEART
This happens rarely. This is mostly likely to happen to people who have or have had heart disease and to those who have had either radiation to the chest or certain types of chemotherapy such as doxorubicin or epirubicin. Tell your doctor if you have chest pain, difficulty breathing, or swelling in the ankles, as these can be signs that bevacizumab is affecting your heart.
CHANGES IN THE KIDNEYS
Bevacizumab can occasionally affect the kidneys. You may have urine and blood tests done to check that your kidneys are working well.
PAIN IN THE AREA OF THE TUMOR
Some people may experience pain in the area of the tumor.
It is important to tell your doctor immediately if you feel unwell or have severe side effects, even if these are not among those mentioned above.
ADDITIONAL INFORMATION ON BEVACIZUMAB
Some drugs, including those bought over the counter in a store or pharmacy, may be harmful to you while you are taking bevacizumab. Tell your doctor if you are taking any medicines, including over-the-counter medications, complementary therapies, and herbal medicines.
Little is known about the effects of bevacizumab on developing babies. Therefore, it is not recommendable to become pregnant while taking this drug.
It is unknown whether bevacizumab is present in semen or vaginal fluid. In order to protect your partner, it is safest to avoid having sex or use a barrier contraceptive device for about 48 hours after the chemotherapy.
There is a potential risk that bevacizumab may be present in breast milk, and therefore women are recommended not to breast feed during the treatment and for a few months afterward.