Avastin Dosing and Administration in First- or Second-line MCRC

Avastin is approved in combination with IV 5-FU–containing chemotherapy.

Avastin dosing1

Avastin, in combination with IV 5-FU–containing chemotherapy, is administered as an IV infusion (5 mg/kg or 10 mg/kg) every 2 weeks until disease progression, per study protocols1,2,4,5

Avastin dosing in MCRC clinical trials1*

Avastin dosing in MCRC clinical trials

  • *Avastin is indicated for use with IV 5-FU–containing regimens.

MCRC trial protocols2,5

Duration of Avastin Therapy

  • Per MCRC trial protocols, Avastin was continued until disease progression and was not modified due to chemotherapy-related toxicity or stopped when tumor response or stable disease was achieved2,4,5

Preparation for administration1

  • Avastin should be diluted for infusion using aseptic technique

  • Withdraw the necessary amount of Avastin to obtain the required dose and dilute in a total volume of 100 mL of 0.9% Sodium Chloride Injection, USP

  • Discard any unused portion left in a vial, as the product contains no preservatives. Inspect visually for particulate matter and discoloration prior to administration

  • Diluted Avastin solutions for infusion may be stored at 2–8°C (36–46°F) for up to 8 hours

  • Avastin infusions should not be administered or mixed with dextrose solutions

Administration1

  • DO NOT ADMINISTER AS AN IV PUSH OR BOLUS

Avastin Administration

  • In clinical trials, infusion reactions with the first dose of Avastin were uncommon (<3%), and severe reactions occurred in 0.2% of patients. Adequate information on rechallenge is not available. Avastin infusion should be interrupted in all patients with severe infusion reactions and appropriate medical therapy administered

Stability and storage1

Avastin vials must be refrigerated at 2–8°C (36–46°F). Avastin vials should be protected from light. Store in the original carton until time of use. DO NOT FREEZE. DO NOT SHAKE.

Treatment discontinuation and suspension

  • Permanently discontinue Avastin in patients with GI perforation (GI perforation, fistula formation in the GI tract, intra-abdominal abscess), fistula formation involving an internal organ, wound dehiscence requiring medical intervention, serious bleeding, severe ATE, nephrotic syndrome, hypertensive crisis, or hypertensive encephalopathy

  • In patients developing RPLS, discontinue Avastin and initiate treatment of hypertension if present. Symptoms usually resolve or improve within days, although some patients have experienced ongoing neurological sequelae

  • Temporary suspension is recommended in patients with evidence of moderate to severe proteinuria, in patients with severe hypertension that is not controlled with medical management, and for at least several weeks prior to elective surgery. Avastin should not be resumed until the surgical incision is fully healed

  • Patients who become pregnant while on Avastin therapy should be counseled regarding possible risk to the fetus and/or loss of pregnancy.

Important treatment considerations — Women of childbearing potential

Prior to initiation of therapy, advise patients of the potential risk of Avastin to the developing fetus. Counsel patients who become pregnant about the possible risks of both continued treatment (including hazard to the fetus and/or loss of pregnancy) and prolonged exposure following discontinuation, keeping in mind the approximate half-life of Avastin (20 days; range 11–50 days).

Next: CRC Resources

References
  1. Avastin Prescribing Information. Genentech, Inc. March 2008.
  1. Hurwitz H, Fehrenbacher L, Novotny W, et al. N Engl J Med. 2004;350:2335-2342.
  1. Giantonio BJ, Catalano PJ, Meropol NJ, et al. J Clin Oncol. 2007;25:1539-1544.
  1. Data on file. Genentech, Inc.