Ovarian Cancer: Avastin Dosing and Usage
Stage III or IV ovarian cancer (OC) after primary surgery
Avastin, in combination with carboplatin and paclitaxel, followed by Avastin as a single agent, is indicated for the treatment of patients with stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgical resection.
Recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer (rOC)
Avastin, in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan, is indicated for the treatment of patients with platinum-resistant recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who received no more than 2 prior chemotherapy regimens.
Avastin, in combination with carboplatin and paclitaxel, or with carboplatin and gemcitabine, followed by Avastin as a single agent, is indicated for the treatment of patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
For your patients with stage III or IV ovarian cancer, add Avastin at cycle 2 after primary surgery and continue with single-agent Avastin for up to 22 cycles
FDA-approved Prescribing Information for the duration of Avastin treatment
q3w=every 3 weeks.
Avastin dosing in psOC and prOC
Avastin has approved dosing for use with chemotherapy in ovarian cancer patients and is administered as a solution for intravenous (IV) infusion at the following dose and schedule:
|Tumor type||Chemotherapy||Avastin dose||Avastin schedule|
|psOC||Carboplatin and gemcitabine (every 3 weeks for 6 to 10 cycles)||15 mg/kg||Every 3 weeks|
|Carboplatin and paclitaxel (every 3 weeks for 6 to 10 cycles)||15 mg/kg||Every 3 weeks|
|prOC||Paclitaxel (every week)||10 mg/kg||Every 2 weeks|
|Pegylated liposomal doxorubicin (every 4 weeks)||10 mg/kg||Every 2 weeks|
|Topotecan (every week)||10 mg/kg||Every 2 weeks|
|Topotecan (every 3 weeks)||15 mg/kg||Every 3 weeks|
psOC=platinum-sensitive ovarian cancer; prOC=platinum-resistant ovarian cancer.
- For patients with psOC, Avastin monotherapy may be continued after completion of combination therapy treatment cycles: Avastin 15 mg/kg IV q3w until disease progression or unacceptable toxicity
- Gastrointestinal (GI) perforation
- Discontinue for gastrointestinal perforation
- Surgery and wound healing complications
- Withhold Avastin for at least 28 days prior to elective surgery. Do not administer Avastin for at least 28 days after surgery and until the wound is fully healed
- Discontinue in patients with wound healing complications requiring medical intervention
- Severe or fatal hemorrhage have occurred
- Do not administer Avastin to patients with serious hemorrhage or recent history of hemoptysis
- Discontinue for Grade 3-4 hemorrhage
Duration of Avastin in psOC and prOC
The FDA-approved Prescribing Information addresses the duration of Avastin treatment: Patients should continue treatment until disease progression or unacceptable toxicity.
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
Important treatment considerations—dose modifications
No dose reductions for Avastin are recommended.
Dose modifications for adverse reactions
|Adverse reaction||Severity||Dose modification|
|Gastrointestinal perforation and fistulae|| ||Discontinue Avastin|
|Wound healing complications|| ||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, 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 ≥2 g/24 h in absence of nephrotic syndrome||Withhold Avastin until proteinuria <2 g/24 h|
|Infusion reaction||Severe infusion reaction||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|