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[1]

FDA-approved Prescribing Information for the duration of Avastin treatment[1]

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[1]:

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

Boxed WARNINGS

  • 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
  • Hemorrhage
    • 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.[1]

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
  • Gastrointestinal perforation, any grade
  • Tracheoesophageal fistula, any grade
  • Fistula, grade 4
  • Fistula formation involving any internal organ
Discontinue Avastin
Wound healing complications
  • Wound healing complications requiring medical intervention
  • 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
  • Arterial thromboembolism, severe
  • Venous thromboembolism, grade 4
Discontinue Avastin
Hypertension
  • Hypertensive crisis
  • Hypertensive encephalopathy
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