Recurrent Glioblastoma: Avastin Dosing and Usage
Recurrent glioblastoma (GBM)
Avastin is indicated for the treatment of recurrent glioblastoma in adults.
Avastin dosing in recurrent glioblastoma
In recurrent glioblastoma (rGBM), Avastin is administered as a solution for intravenous (IV) infusion at the following dosage:
|Tumor type||Avastin dose||Avastin schedule|
|rGBM*||10 mg/kg IV||Every 2 weeks|
*10 mg/kg dose evaluated for rGBM.
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 in rGBM
The FDA-approved Prescribing Information addresses the duration of Avastin treatment: 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.|
|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, 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|
|Select NCCN Guidelines |
|Inclusion of bevacizumab in National Comprehensive Cancer
Network® (NCCN®) recommendations |
|Bevacizumab as a single agent or in combination with
chemotherapy is included in NCCN recommendations for recurrent
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