About Avastin: Dosing
Avastin dosing in approved cancer types
Avastin is administered as a solution for intravenous (IV) infusion at the following doses and schedules:
|Tumor type||Combination regimen||Avastin dose||Avastin schedule|
|MCRC||IFL* (First-line Study 2107)||5 mg/kg IV||Every 2 weeks|
|FOLFOX4† (Second-line Study E3200)||10 mg/kg IV||Every 2 weeks|
chemotherapy in patients who had progressed on a first-line
(First- through second-line TML study§)
|5 mg/kg IV||Every 2 weeks|
|7.5 mg/kg IV||Every 3 weeks|
|NSCLC||||PC||15 mg/kg IV||Every 3 weeks|
|mRCC¶||IFN||10 mg/kg IV||Every 2 weeks|
|CC#||Cisplatin/paclitaxel or topotecan/paclitaxel||15 mg/kg IV||Every 3 weeks|
|OC||Carboplatin and paclitaxel**||15 mg/kg IV||Every 3 weeks|
|psOC††||Carboplatin and gemcitabine||15 mg/kg IV||Every 3 weeks|
|Carboplatin and paclitaxel||15 mg/kg IV||Every 3 weeks|
|prOC‡‡||Paclitaxel (weekly)||10 mg/kg IV||Every 2 weeks|
|Topotecan (every 3 weeks)||15 mg/kg IV||Every 3 weeks|
|rGBM§§||None (single agent)||10 mg/kg IV||Every 2 weeks|
|HCCIIII||Atezolizumab||15 mg/kg IV||Every 3 weeks|
*5 mg/kg IV dose evaluated in first-line MCRC in
combination with 5-fluorouracil (5-FU)/leucovorin (LV)/irinotecan
†10 mg/kg IV dose evaluated in second-line, Avastin-naive MCRC patients in combination with 5-FU/LV/oxaliplatin (FOLFOX4).[1,4]
‡5 mg/kg IV every 2 weeks and 7.5 mg/kg IV every 3 weeks doses evaluated, in combination with fluoropyrimidine and either irinotecan- or oxaliplatin-containing chemotherapy, in MCRC patients who had progressed on a first-line Avastin-containing regimen.
§TML=Treatment through Multiple Lines (first and second line).
||15 mg/kg IV dose evaluated in first-line locally advanced or metastatic non-squamous NSCLC in combination with paclitaxel + carboplatin (PC). Avastin plus PC was given for up to 6 cycles, after which Avastin was continued alone until disease progression or unacceptable toxicity.
¶10 mg/kg IV dose evaluated in mRCC in combination with interferon alfa (IFN). AVOREN protocol allowed for IFN dose escalation (attaining a dose of 9 million international units [MIU] within the first 2 weeks), reduction, or discontinuation. IFN was discontinued after 52 weeks or earlier.[3,14]
#15 mg/kg IV dose evaluated in CC in combination with cisplatin/paclitaxel or topotecan/paclitaxel. Treatment was given until disease progression or unacceptable toxicity.
**15 mg/kg IV dose evaluated in stage III or IV OC following initial surgical resection in combination with carboplatin and paclitaxel. Avastin plus carboplatin and paclitaxel was given for up to 6 cycles, after which Avastin was continued alone for a total of up to 22 cycles, or until disease progression or unacceptable toxicity.
††15 mg/kg IV dose evaluated in psOC in combination with carboplatin and paclitaxel for 6-8 cycles or carboplatin and gemcitabine for 6-10 cycles after which Avastin was continued alone until disease progression.
‡‡10 mg/kg IV dose evaluated in prOC in combination with weekly paclitaxel, PLD (pegylated liposomal doxorubicin), or weekly topotecan, and 15 mg/kg IV dose evaluated in combination with topotecan administered every 3 weeks. Treatment was given until disease progression or unacceptable toxicity.
§§10 mg/kg IV dose evaluated as a single agent for rGBM that has progressed following prior therapy.
IIII15 mg/kg IV dose evaluated in HCC after IV administration of 1200 mg of atezolizumab on the same day, every 3 weeks until disease progression or unacceptable toxicity.
Recurrent glioblastoma (GBM)
Avastin is indicated for the treatment of recurrent glioblastoma in adults.
Important treatment considerations—Women of childbearing potential
- Avastin increases the risk of ovarian failure and may impair fertility. Inform females of reproductive potential of the risk of ovarian failure prior to the first dose of Avastin
- Long-term effects of Avastin exposure on fertility are unknown
- Patients should also use effective contraception during treatment and for 6 months following the last dose of Avastin
- Nursing mothers should not breastfeed during treatment and for 6 months following their last dose of treatment
Duration of Avastin treatment
The FDA-approved Prescribing Information addresses the duration of
Patients should continue treatment until disease progression or unacceptable toxicity.
Important treatment considerations—Dose modifications
No dose reductions for Avastin are recommended.
Dose Modifications for Adverse Reactions
|Adverse reaction||Severity||Dosage modification|
|Gastrointestinal Perforation and Fistulae|| ||Discontinue Avastin|
|Wound Healing Complications||Any||Withhold Avastin until adequate wound healing. The safety of resumption of Avastin after resolution of wound healing complications has not been established.|
| ||Discontinue Avastin|
|Hemorrhage|| ||Discontinue Avastin|
| ||Withhold Avastin|
|Thromboembolic Events|| ||Discontinue Avastin|
| ||Discontinue Avastin|
|Hypertension|| ||Discontinue Avastin|
| ||Withhold Avastin if not controlled with medical management; resume once controlled|
|Posterior Reversible Encephalopathy Syndrome (PRES)||Any||Discontinue Avastin|
|Renal Toxicity and Proteinuria|| ||Discontinue Avastin|
| ||Withhold Avastin until proteinuria less than 2 grams per 24 hours|
|Infusion-Related Reaction|| ||Discontinue Avastin|
| ||Interrupt infusion; resume at a decreased rate of infusion after symptoms resolve|
| ||Decrease infusion rate|
|Congestive Heart Failure||Any||Discontinue Avastin|