Avastin (bevacizumab) is FDA-approved for treating several types of cancer and is one of the most commonly used anti-angiogenesis medications for cancers like colorectal and non-small cell lung cancer. In early clinical trials, Avastin showed potential for extending the life expectancy of mesothelioma patients. Despite concerns about side effects, the National Comprehensive Cancer Network (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
- Metastatic renal cell carcinoma
- Cervical cancer
- Some cases of epithelial peritoneal, fallopian tube, and ovarian cancers
The NCCN recommends the use of Avastin in mesothelioma. Intravenous doses are given over a period of thirty to ninety 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 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. Avastin’s most common side effects are:
- Nasal congestion
- High blood pressure
- Excessive protein in the urine
- Canges in the ability to taste
- Back pain
- Dry, peeling skin
- 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 the FDA approved Avastin, researchers began investigating 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.
The Risk of Death
There have been many clinical trials using Avastin, either alone or in combination. Researchers discovered a disturbing trend from a meta-analysis (combining the results of several trials to see possible trends): 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 sixteen 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. Avastin has been shown to help improve the ability to treat the disease for patients who have mesothelioma and don’t have a history of bleeding.Get Your FREE Mesothelioma Packet
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.