Avastin ® Avastin® Generic name: Bevacizumab Biosimilar: Mvasi® A biosimilar is a biologic medical product that is almost an identical copy of an original medication that is manufactured by a different pharmaceutical company. Chemocare.com uses generic names in all descriptions of drugs. Avastin is the trade name for Bevacizumab. In some cases, health care professionals may use the trade name Avastin when referring to the generic drug name Bevacizumab. Drug type: Avastin is classified as a "monoclonal antibody" and "anti-angiogenesis" drug. (For more detail, see "How this drug works" section below.) What Avastin Is Used For: Treatment of metastatic colon or rectal cancer, used as part of a combination chemotherapy regimen. Treatment for non-squamous, non-small cell lung cancer. Treatment of metastatic breast cancer used as part of a combination chemotherapy regimen. Treatment of glioblastoma (GBM). Treatment of metastatic renal cell carcinoma. Note: If Avastin has been approved for one use, physicians may elect to use avastin for other problems if they believe it may be helpful. How Avastin Is Given: Avastin is given through an infusion into a vein (intravenous, IV). The first dose is given over 90 minutes. The infusion time can eventually be shortened to 30 minutes if well-tolerated. The amount of avastin that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule. Side Effects of Avastin: Important things to remember about the side effects of avastin: Most people do not experience all of the side effects listed. Side effects are often predictable in terms of their onset and duration. Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects. There is no relationship between the presence or severity of side effects and the effectiveness of the medication. There is no data as to the frequency of adverse reactions that may be attributed to avastin alone. (In clinical studies avastin was used in combination with other chemotherapy medications). The following side effects are common (occurring in greater than 30%) for patients taking avastin: Generalized Weakness Pain Abdominal pain Nausea & vomiting Poor appetite Constipation Upper respiratory infection Low white blood cell count. (This can put you at increased risk for infection.) Proteinuria (see kidney problems) Nose bleed (see bleeding problems) Diarrhea Hair loss Mouth sores Headache These side effects are less common side effects (occurring in about 10-29%) of patients receiving avastin: Shortness of breath Dizziness High blood pressure Weight loss Muscle aches and pains These are rare but serious complications of avastin therapy. Gastrointestinal perforation/ fistula formation/ wound healing complications Hemorrhage (severe bleeding) Hypertensive crisis (severe high blood pressure) Nephrotic Syndrome - a condition marked by very high levels of protein in the urine (proteinuria), low levels of protein in the blood, swelling, especially around the eyes, feet and hands. This syndrome is caused by damage to the glomeruli (tiny blood vessels in the kidney that filter waste and excess water from the blood and send them to the bladder as urine). Congestive heart failure in patients who have received prior treatment with anthracycline based chemotherapy, or radiation therapy to the chest wall. Delayed effects: Based on animal studies, avastin may disrupt normal menstrual cycles and impair fertility by several effects. Some parameters do not recover completely, or recover very slowly following discontinuation of the drug. Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms. When to contact your doctor or health care provider: Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: Fever of 100.4° F (38° C) or higher, chills (possible signs of infection) Severe bleeding Shortness of breath, difficulty breathing The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: Swelling of the feet or ankles. Sudden weight gain. Abdominal pain Nausea (interferes with ability to eat and unrelieved with prescribed medication). Vomiting (vomiting more than 4-5 times in a 24 hour period). Diarrhea (4-6 episodes in a 24-hour period). Constipation unrelieved by laxative use. Coughing up blood. Black or tarry stools, or blood in your stools. Blood in the urine. Mouth sores (painful redness, swelling or ulcers). Swelling, redness and/or pain in one leg or arm and not the other. Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination. Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness. Always inform your health care provider if you experience any unusual symptoms. Precautions: Before starting avastin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not receive any kind of immunization or vaccination without your doctor's approval while taking avastin. Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). For both men and women: Do not conceive a child (get pregnant) while taking avastin . Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy. Do not breast feed while taking avastin. Self-Care Tips: Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help. Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by avastin. Wash your hands often. You may be at risk of infection report fever or any other signs of infection immediately to your health care provider. To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water. Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. Get plenty of rest. Maintain good nutrition. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems. Monitoring and Testing: You will be checked regularly by your health care professional while you are taking avastin, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. How Avastin Works: Monoclonal antibodies are a relatively new type of "targeted" cancer therapy. Antibodies are part of the immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) entering the body. The antibodies attach to the antigen in order to mark it for destruction by the body's immune system. In the laboratory, scientists analyze specific antigens on the surface of cancer cells (target) to determine a protein to match the antigen. Then, using animal and human proteins, scientists work to create a special antibody that will attach to the target antigen. Antibodies will attach to matching antigens like a key fits a lock. This technology allows treatment to target specific cells, causing less toxicity to healthy cells. Monoclonal antibody therapy can be done only for cancers in which antigens (and the respective antibodies) have been identified. Avastin works by interfering with the process of angiogenesis by targeting and inhibiting human vascular endothelial growth factor (VEGF). VEGF is a cytokine (a small protein A valid prescription should be available upon delivery

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