First-line non-squamous non-small cell lung cancer (NSCLC)
Avastin, in combination with carboplatin and paclitaxel, is indicated for the first‑line treatment of patients with unresectable, locally advanced, recurrent or metastatic non–squamous non–small cell lung cancer.
In advanced nsNSCLC, Avastin is administered as a solution for intravenous (IV) infusion at the following dose and schedule[1]:
Tumor type | Chemotherapy | Avastin dose | Avastin schedule |
---|---|---|---|
NSCLC* | Paclitaxel/carboplatin | 15 mg/kg IV | Every 3 weeks |
*15 mg/kg IV dose evaluated in first-line locally advanced or metastatic nsNSCLC 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.[1]
The FDA-approved Prescribing Information addresses the duration of Avastin treatment: Patients should continue treatment until disease progression or unacceptable toxicity.[1]
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 |
NCCN Guidelines® include bevacizumab plus PC as a treatment option for first-line nsNSCLC patients using the following criteria |
---|
|
ECOG PS=Eastern Cooperative Oncology Group performance status.
NCCN Guidelines® | Bevacizumab should be given until progression. Bevacizumab should not be given as a single agent, unless as maintenance if initially used with chemotherapy. |
---|
†Maintenance therapy, as defined by the NCCN.
Continuation maintenance | Use of at least 1 of the agents given in first line, beyond 4–6 cycles, in the absence of disease progression. |
---|
In nsNSCLC, Avastin’s approval is only in first line and as treatment to progression or unacceptable toxicity[1]
Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.5.2019. © 2019 National Comprehensive Cancer Network, Inc. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application in any way. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available.[9]
‡Chemotherapy given for up to 6 cycles.[1,8]
§PS 0–1 non-squamous NSCLC and no recent history of hemoptysis. Bevacizumab should not be given as a single agent unless as maintenance if initially used with chemotherapy. Any regimen with a high risk of thrombocytopenia and the potential risk of bleeding should be used with caution in combination with bevacizumab.[9]
Avastin Prescribing Information. Genentech, Inc. 2022.
Avastin Prescribing Information. Genentech, Inc. 2022.
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Data on file. Genentech, Inc.
Data on file. Genentech, Inc.
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