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Avastin is the brand name for a chemotherapy drug called bevacizumab. It is manufactured by Genentech and is FDA-approved for the treatment of several types of cancer. Avastin is one of the most commonly used anti-angiogenesis medications for cancers like colorectal and non-small cell lung cancer (NSCLC). It is also currently used in combination with chemotherapy to treat mesothelioma.
In early clinical trials, Avastin showed potential for extending the life expectancy of mesothelioma patients. However, there are some serious side effects beyond the typical nausea and fatigue chemotherapy patients often experience. Despite the concerns, the NCCN guidelines list Avastin as a key piece of early treatment for mesothelioma.
What is Bevacizumab?
Avastin (bevacizumab), is a biological agent approved by the FDA in 2004. Administered intravenously, the drug circulates in the bloodstream and acts on tumors by inhibiting the growth of new blood vessels. Avastin is only approved for use in certain types of cancer, as studies have shown it to not be effective in all types.
FDA-approved uses for Avastin include metastatic colorectal cancer, non-squamous non-small cell lung cancer, glioblastoma, metastatic renal cell carcinoma, cervical cancer, and some cases of epithelial peritoneal, fallopian tube, and ovarian cancers. The NCCN further recommends the use of Avastin in mesothelioma. Intravenous doses are given over a period of 30 to 90 minutes every two to three weeks.
How it Works
Most chemotherapy drugs work by being circulated through the blood, attacking any rapidly growing and dividing cells. This mostly targets fast-growing tumor cells, but simultaneously affects healthy cells. The result is the characteristic side effects of chemotherapy, like hair loss. Avastin is not a chemotherapy drug, but is often used as a helper to chemotherapy because it works differently than most other medications.
Avastin inhibits a process in tumors called angiogenesis. Angiogenesis is the growth of new blood vessels supplying tumors with blood carrying oxygen and nutrients. By inhibiting this process, Avastin slows tumor growth and some cancerous cells may even die. While this is an effective way to destroy the cancer, it is not specific to the tumor. The inhibition of angiogenesis can affect healthy systems, causing high blood pressure, coronary artery disease, and kidney disease, among other side effects.
As with other medications, Avastin has potential side effects. However, these side effects differ because this drug works in a unique way. The most common side effects of Avastin are nosebleeds, headaches, nasal congestion, high blood pressure, excessive protein in the urine, changes in ability to taste, back pain, dry skin, peeling skin, and rectal hemorrhage.
Avastin comes with several warnings and precautions because it can cause serious adverse effects in some patients. Some side effects are listed in a black box warning, the FDA’s most serious warning label. These serious side effects include a risk of gastrointestinal perforation, occurring in over three percent of patients treated with Avastin. Other serious side effects include bleeding and difficulty healing.
Avastin for Mesothelioma – Ongoing Trials
After Avastin was approved by the FDA, researchers began investigation into how this drug might help patients with mesothelioma. Clinical trials using Avastin in mesothelioma patients have been conducted with mixed results. Some studies have found little improvement in patients when including Avastin in combination with cisplatin and gemcitabine, while others show the addition of Avastin can help patients. This research includes a case study in which a man with peritoneal mesothelioma did not respond well to other treatment regimens, but saw marked improvement with Avastin. Additional studies investigate combining Avastin with Tarceva® (erlotinib) and more.
The Risk of Death
There have been many clinical trials using Avastin, either alone or in combination. From a meta-analysis (combining the results of several trials to see possible trends), researchers discovered a disturbing trend: there is a serious risk of death when Avastin is combined with more standard chemotherapy drugs. The results of this meta-analysis were published in 2011.
The analysis included more than 10,000 patients from 16 clinical trials. While fatalities were uncommon, they did note a trend. Researchers observed a statistically significant difference between the 2.9 percent of patients who received Avastin and died compared to 2.2 percent of patients not receiving Avastin. The most common cause of death was hemorrhaging, followed by infections and gastrointestinal perforations.
Researchers ultimately concluded that, for most patients, the risks of these potentially fatal side effects are outweighed by the benefits of combining Avastin with chemotherapy. They did point out, however, that knowing the risks is important for patients and doctors.
Avastin is an anti-angiogenesis medication used in combination with many different chemotherapy drugs to help treat multiple types of cancer. Many patients receiving Avastin have undergone other treatments with varying success. These patients are seeking an alternative despite the risks of serious adverse side effects. For patients who have mesothelioma and don’t have a history of bleeding, Avastin has been shown to help improve the ability to treat the disease.
Page Medically Reviewed and Edited by Kyle J. Becker, PharmD, MBA, BCOP
Kyle J. Becker, PharmD is certified by the Board of Pharmacy Specialties in Oncology Pharmacy. Dr. Becker earned his pharmacy degree from Shenandoah University and he currently serves as an oncology pharmacist at Parkview Cancer Institute.