Teach the patient to:
• Expect routine blood pressure monitoring, when the nurse gives bevacizumab(Drug information on bevacizumab). An antihypertensive medicine may be prescribed if blood pressure is elevated.
• Report immediately any unusual bleeding, high fever, chills or rigors, sudden onset or worsening of neurological function, persistent or severe abdominal pain that may be associated with constipation and/or vomiting.
• Expect drug will be stopped at least 4 weeks before surgery, and held until after the surgical wound has healed, as drug causes an increased risk of wound healing complications during and after bevacizumab treatment.
• Report immediately changes in neurological function, chest pain, difficulty breathing, or other changes, as drug may increase risk of an arterial thromboembolic event.
• Use effective contraception during treatment and for at least 6 months after treatment ends, as bevacizumab may damage the fetus if pregnancy occurs.
• Ensure that patient has name and telephone number(s) of healthcare provider(s) who should be contacted if any of the previously described problems develop.
Chemotherapy and bevacizumab: increased risk of neutropenia. Paclitaxel(Drug information on paclitaxel), carboplatin(Drug information on carboplatin), and bevacizumab: substantially lower paclitaxel serum levels after four cycles of treatment (day 63) vs those of patients not receiving bevacizumab. Incompatible with dextrose(Drug information on dextrose) solution.
Discontinue bevacizumab in cases of:
• Gastrointestinal (GI) perforation, fistula formation involving an internal organ or GI tract.
• Wound dehiscence and wound healing complications requiring medical intervention.
• Serious hemorrhage requiring medical intervention.
• Severe arterial thromboembolic events.
• Hypertensive crisis or hypertensive encephalopathy.
• Reversible posterior leukoencephalopathy syndrome (RPLS).
• Nephrotic syndrome.
Temporarily suspend bevacizumab:
• At least 4 weeks prior to elective surgery.
• In cases of severe hypertension not controlled with medical management.
• When patient has moderate to severe proteinuria
pending further evaluation (urine protein equal to or greater than 2 grams/24 hours).
• If severe infusion reactions develop.
Drug is teratogenic, so patients should be counseled to continue effective contraception for at least 6 months after treatment ends; in addition, the drug should not be given to nursing mothers.
Hapani et al. completed a meta-analysis of gastrointestinal perforation in patients receiving bevacizumab, and found the risk was dependent on dose (with lowest risk at a dose of 2.5 mg/kg/weekly, which was not statistically significant, vs 5 mg/kg/week, which carried a significantly higher risk) as well as tumor type (higher in patients with renal cell cancer, relative risk [RR] of 5.67, followed by those with metastatic colorectal cancer, RR 3.10).
No contraindications. Patients with glioblastoma may develop dehiscence at the craniotomy site, owing to the compound effects of irradiation together with those of bevacizumab, and this usually requires reoperation. If patients with glioblastoma develop a thromboembolic event, it is unknown whether therapeutic anticoagulation would increase the risk of hemorrhage into the glioblastoma.