Metastatic colorectal cancer (MCRC)
Avastin, in combination with intravenous fluorouracil-based chemotherapy, is indicated for the first‑ or second‑line treatment of patients with metastatic colorectal cancer.
Avastin, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy, is indicated for the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line bevacizumab product-containing regimen.
Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.
In MCRC, Avastin is administered as a solution for intravenous (IV) infusion at the following doses and schedules[1]:
Tumor type | Chemotherapy | Avastin dose | Avastin schedule |
---|---|---|---|
MCRC | IFL* (first-line Study 2107) | 5 mg/kg IV | Every 2 weeks |
10 mg/kg IV | Every 2 weeks | ||
5 mg/kg IV | Every 2 weeks | ||
7.5 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 (IFL).
†10 mg/kg IV dose evaluated in second-line, Avastin-naive MCRC patients in combination with 5-FU/LV/oxaliplatin (FOLFOX4).
‡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 bevacizumab product-containing regimen.
§TML=Treatment through Multiple Lines (first and second line).
||Oxaliplatin→irinotecan or irinotecan→oxaliplatin.
The FDA-approved Prescribing Information addresses the duration of Avastin treatment[1]:
Patients should continue treatment until disease progression or unacceptable toxicity.
Metastatic colorectal cancer (MCRC)
Avastin, in combination with intravenous fluorouracil-based chemotherapy, is indicated for the first‑ or second‑line treatment of patients with metastatic colorectal cancer.
Avastin, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy, is indicated for the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line bevacizumab product-containing regimen.
Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.
No dose reductions for Avastin are recommended.
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. |
Necrotizing fasciitis | Discontinue Avastin | |
Hemorrhage | Grade 3 or 4 | Discontinue Avastin |
Recent history of hemoptysis of ½ teaspoon (2.5 mL) or more | Withhold Avastin | |
Thromboembolic events |
|
Discontinue Avastin |
Hypertension |
|
Discontinue Avastin |
Hypertension, severe | Withhold Avastin if not controlled with medical management; resume once controlled | |
Posterior reversible encephalopathy syndrome (PRES) | Any | Discontinue Avastin |
Renal toxicity and proteinuria | Nephrotic syndrome | Discontinue Avastin |
Proteinuria greater than or equal to 2 grams per 24 hours in absence of nephrotic syndrome |
Withhold Avastin until proteinuria less than 2 grams per 24 hours |
|
Infusion-related reaction | Severe | Discontinue Avastin |
Clinically significant | Interrupt infusion; resume at a decreased rate of infusion after symptoms resolve | |
Mild, clinically insignificant | Decrease infusion rate | |
Congestive heart failure | Any | Discontinue Avastin |
First-line MCRC | Second-line MCRC |
---|---|
Bevacizumab plus • FOLFIRI • FOLFOX • IV 5-FU/LV • FOLFOXIRI |
Bevacizumab plus • FOLFIRI • FOLFOX
|
Bevacizumab continued through first- and second-line MCRC | |
Bevacizumab plus • FOLFIRI • FOLFOX • CapeOX |
FOLFIRI=5-FU/LV/irinotecan; FOLFOX=5-FU/LV/oxaliplatin; FOLFOXIRI=5-FU/LV/oxaliplatin/irinotecan; CapeOX=capecitabine/oxaliplatin.
The NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Avastin Prescribing Information. Genentech, Inc. 2022.
Avastin Prescribing Information. Genentech, Inc. 2022.
Hurwitz H, Fehrenbacher L, Novotny W, et al. N Engl J Med. 2004;350:2335-2342. PMID: 15175435
Hurwitz H, Fehrenbacher L, Novotny W, et al. N Engl J Med. 2004;350:2335-2342. PMID: 15175435
Data on file. Genentech, Inc.
Data on file. Genentech, Inc.
Bennouna J, Sastre J, Arnold D, et al. Lancet Oncol. 2013;14:29-37.
Bennouna J, Sastre J, Arnold D, et al. Lancet Oncol. 2013;14:29-37.
Österlund P, Alonso-Orduña V, Schlichting C, et al. Poster presented at: European Society for Medical Oncology Meeting; September 28-October 2, 2012; Vienna, Austria.
Österlund P, Alonso-Orduña V, Schlichting C, et al. Poster presented at: European Society for Medical Oncology Meeting; September 28-October 2, 2012; Vienna, Austria.
Giantonio BJ, Catalano PJ, Meropol NJ, et al. J Clin Oncol. 2007;25:1539-1544. PMID: 17442997
Giantonio BJ, Catalano PJ, Meropol NJ, et al. J Clin Oncol. 2007;25:1539-1544. PMID: 17442997
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.2.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.2.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Sandler A, Gray R, Perry MC, et al. N Engl J Med. 2006;355:2542-2550. PMID: 17167137
Sandler A, Gray R, Perry MC, et al. N Engl J Med. 2006;355:2542-2550. PMID: 17167137
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.5.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.5.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Sandler AB, Schiller JH, Gray R, et al. J Clin Oncol. 2009;27:1405-1412.
Sandler AB, Schiller JH, Gray R, et al. J Clin Oncol. 2009;27:1405-1412.
Cohen MH, Gootenberg J, Keegan P, Pazdur R. Oncologist. 2007;12:713-718.
Cohen MH, Gootenberg J, Keegan P, Pazdur R. Oncologist. 2007;12:713-718.
Sandler A, Leon L, Fages S, et al. Poster presented at: World Conference on Lung Cancer; July 3-7, 2011; Amsterdam, The Netherlands.
Sandler A, Leon L, Fages S, et al. Poster presented at: World Conference on Lung Cancer; July 3-7, 2011; Amsterdam, The Netherlands.
Escudier B, Bellmunt J, Negrier S, et al. Slides presented at: Annual Meeting of the American Society of Clinical Oncology; May 29-June 2, 2009; Orlando, FL.
Escudier B, Bellmunt J, Negrier S, et al. Slides presented at: Annual Meeting of the American Society of Clinical Oncology; May 29-June 2, 2009; Orlando, FL.
Escudier B, Pluzanska A, Koralewski P, et al. Lancet. 2007;370:2103-2111. PMID: 18156031
Escudier B, Pluzanska A, Koralewski P, et al. Lancet. 2007;370:2103-2111. PMID: 18156031
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Kidney Cancer V.1.2020. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Kidney Cancer V.1.2020. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Tewari KS, Sill MW, Long HJ III, et al. N Engl J Med. 2014;370:734-743 [supplementary appendix appears online].
Tewari KS, Sill MW, Long HJ III, et al. N Engl J Med. 2014;370:734-743 [supplementary appendix appears online].
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cervical Cancer V.4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 25, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cervical Cancer V.4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 25, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Rich JT, Neely JG, Paniello RC, et al. Otolaryngol Head Neck Surg. 2010;143:331-336.
Rich JT, Neely JG, Paniello RC, et al. Otolaryngol Head Neck Surg. 2010;143:331-336.
Burger RA, Brady MF, Bookman MA, et al. N Engl J Med. 2011;365:2473-2483.
Burger RA, Brady MF, Bookman MA, et al. N Engl J Med. 2011;365:2473-2483.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Aghajanian C, Blank S, Goff B, et al. J Clin Oncol. 2012;30(17):2039-2045.
Aghajanian C, Blank S, Goff B, et al. J Clin Oncol. 2012;30(17):2039-2045.
Aghajanian C, Goff B, Nycum LR, et al. Gynecol Oncol. 2015;139(1):10-16.
Aghajanian C, Goff B, Nycum LR, et al. Gynecol Oncol. 2015;139(1):10-16.
Coleman RL, Brady MF, Herzog TJ, et al. Lancet Oncol. 2013;18(6):779-791.
Coleman RL, Brady MF, Herzog TJ, et al. Lancet Oncol. 2013;18(6):779-791.
Pujade-Lauraine E, Hilpert F, Weber B, et al. J Clin Oncol. 2014;32(13):1302-1308.
Pujade-Lauraine E, Hilpert F, Weber B, et al. J Clin Oncol. 2014;32(13):1302-1308.
Bevacizumab and lomustine for recurrent GBM. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01290939. Updated February 21, 2018. Accessed July 24, 2019.
Bevacizumab and lomustine for recurrent GBM. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01290939. Updated February 21, 2018. Accessed July 24, 2019.
Friedman HS, Prados MD, Wen PY, et al. J Clin Oncol. 2009;27:4733-4740.
Friedman HS, Prados MD, Wen PY, et al. J Clin Oncol. 2009;27:4733-4740.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Central Nervous System Cancers V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Central Nervous System Cancers V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 24, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org.
Hicklin DJ, Ellis LM. J Clin Oncol. 2005;23:1011-1027.
Hicklin DJ, Ellis LM. J Clin Oncol. 2005;23:1011-1027.
Bergers G, Benjamin LE. Nat Rev Cancer. 2003;3:401-410.
Bergers G, Benjamin LE. Nat Rev Cancer. 2003;3:401-410.
Folkman J. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. Vol 2. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:2865-2882.
Folkman J. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. Vol 2. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:2865-2882.
Hanrahan V, Currie MJ, Gunningham SP, et al. J Pathol. 2003;200:183-194.
Hanrahan V, Currie MJ, Gunningham SP, et al. J Pathol. 2003;200:183-194.
Rini BI, Small EJ. J Clin Oncol. 2005;23:1028-1043.
Rini BI, Small EJ. J Clin Oncol. 2005;23:1028-1043.
Presta LG, Chen H, O’Connor SJ, et al. Cancer Res. 1997;57:4593-4599.
Presta LG, Chen H, O’Connor SJ, et al. Cancer Res. 1997;57:4593-4599.
Ferrara N. Endocr Rev. 2004;25:581-611.
Ferrara N. Endocr Rev. 2004;25:581-611.
Ferrara N, Hillan KJ, Gerber HP, et al. Nat Rev Drug Discov. 2004;3:391-400.
Ferrara N, Hillan KJ, Gerber HP, et al. Nat Rev Drug Discov. 2004;3:391-400.
O’Connor JPB, Carano RAD, Clamp AR, et al. Clin Cancer Res. 2009;15:6674-6682.
O’Connor JPB, Carano RAD, Clamp AR, et al. Clin Cancer Res. 2009;15:6674-6682.
Tobelem G. Targ Oncol. 2007;2:153-164.
Tobelem G. Targ Oncol. 2007;2:153-164.
Yuan F, Chen Y, Dellian M, et al. Proc Natl Acad Sci U S A. 1996;93:14765-14770.
Yuan F, Chen Y, Dellian M, et al. Proc Natl Acad Sci U S A. 1996;93:14765-14770.
Willett CG, Boucher Y, di Tomaso E, et al. Nat Med. 2004;10:145-147.
Willett CG, Boucher Y, di Tomaso E, et al. Nat Med. 2004;10:145-147.
Lee CG, Heijn M, di Tomaso E, et al. Cancer Res. 2000;60:5565-5570.
Lee CG, Heijn M, di Tomaso E, et al. Cancer Res. 2000;60:5565-5570.
Gerber HP, Ferrara N. Cancer Res. 2005;65:671-680.
Gerber HP, Ferrara N. Cancer Res. 2005;65:671-680.
Yanagisawa M, Yorozu K, Kurasawa M, et al. Anti-Cancer Drugs. 2010;21:687-694.
Yanagisawa M, Yorozu K, Kurasawa M, et al. Anti-Cancer Drugs. 2010;21:687-694.
Borgström P, Hillan KJ, Sriramarao P, et al. Cancer Res. 1996;56:4032-4039.
Borgström P, Hillan KJ, Sriramarao P, et al. Cancer Res. 1996;56:4032-4039.
Borgström P, Bourdon MA, Hillan KJ, et al. Prostate. 1998;35:1-10.
Borgström P, Bourdon MA, Hillan KJ, et al. Prostate. 1998;35:1-10.
Bagri A, Berry L, Gunter B, et al. Clin Cancer Res. 2010;16:3887-3900 [and supplemental appendix].
Bagri A, Berry L, Gunter B, et al. Clin Cancer Res. 2010;16:3887-3900 [and supplemental appendix].
Warren RS, Yuan H, Matli MR, et al. J Clin Invest. 1995;95:1789-1797.
Warren RS, Yuan H, Matli MR, et al. J Clin Invest. 1995;95:1789-1797.
Mabuchi S, Terai Y, Morishige K, et al. Clin Cancer Res. 2008;14:7781-7789.
Mabuchi S, Terai Y, Morishige K, et al. Clin Cancer Res. 2008;14:7781-7789.
Nagy JA, Dvorak AM, Dvorak HF. Annu Rev Pathol. 2007;2:251-275.
Nagy JA, Dvorak AM, Dvorak HF. Annu Rev Pathol. 2007;2:251-275.
Galizia G, Lieto E, Ferraraccio F, et al. Clin Cancer Res. 2004;10:3490-3499.
Galizia G, Lieto E, Ferraraccio F, et al. Clin Cancer Res. 2004;10:3490-3499.
Vosseler S, Mirancea N, Bohlen P, et al. Cancer Res. 2005;65:1294-1305.
Vosseler S, Mirancea N, Bohlen P, et al. Cancer Res. 2005;65:1294-1305.
MMIT Analysis.
MMIT Analysis.
IQVIA Plantrak Corticosteroid Data.
IQVIA Plantrak Corticosteroid Data.
HLI lives database.
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