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Vegzelma (bevacizumab-adcd)
bevacizumab
Adult Dosing .
Dosage forms: INJ
Special Note
- [formulation clarification]
- Info: nonproprietary name = bevacizumab-adcd
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; D/C >28 days before elective surgery, restart >28 days after major surgery when wound fully healed
colorectal CA, metastatic
- [combo w/ bolus-IFL]
- Dose: 5 mg/kg/dose IV x1 on day 1 of 14-day cycle
- [combo w/ FOLFOX4]
- Dose: 10 mg/kg/dose IV x1 on day 1 of 14-day cycle
- [combo w/ fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin]
- Dose: 5 mg/kg/dose IV x1 on day 1 of 14-day cycle; Alt: 7.5 mg/kg/dose IV x1 on day 1 of 21-day cycle; Info: for pts w/ progressive dz on bevacizumab-containing regimen
nonsquamous non-small cell lung CA, first-line tx
- [15 mg/kg/dose IV x1 on day 1 of 21-day cycle]
- Info: for pts w/ unresectable, locally advanced, recurrent or metastatic dz; part of multi-drug chemo regimen
glioblastoma, recurrent
- [10 mg/kg/dose IV x1 on day 1 of 14-day cycle]
renal cell CA, metastatic
- [10 mg/kg/dose IV x1 on day 1 of 14-day cycle]
- Info: use w/ interferon alfa
cervical CA, persistent or recurrent or metastatic
- [15 mg/kg/dose IV x1 on day 1 of 21-day cycle]
- Info: part of multi-drug chemo regimen
ovarian CA
- [stage III-IV dz]
- Dose: 15 mg/kg/dose IV x1 on day 1 of 21-day cycle for up to 22 cycles; Info: for epithelial ovarian, fallopian tube, or primary peritoneal CA following initial surgical resection; part of multi-drug chemo regimen for up to 1st 6 cycles
- [first-line tx, advanced homologous recombination deficiency-positive dz (off-label)]
- Dose: 15 mg/kg/dose IV x1 on day 1 of 21-day cycle x15mo; Info: for epithelial ovarian, fallopian tube, or primary peritoneal CA; use w/ platinum-based chemo for at least 4 cycles, then use w/ olaparib maintenance tx for total of 15mo
- [recurrent, platinum-sensitive dz]
- Dose: 15 mg/kg/dose IV x1 on day 1 of 21-day cycle; Info: for epithelial ovarian, fallopian tube, or primary peritoneal CA; part of multi-drug chemo regimen for 1st 6-10 cycles
- [recurrent, platinum-resistant dz, 14-day cycle]
- Dose: 10 mg/kg/dose IV x1 on day 1 of 14-day cycle; Info: for epithelial ovarian, fallopian tube, or primary peritoneal CA; use w/ paclitaxel, doxorubicin liposomal, or topotecan
- [recurrent, platinum-resistant dz, 21-day cycle]
- Dose: 15 mg/kg/dose IV x1 on day 1 of 21-day cycle; Info: for epithelial ovarian, fallopian tube, or primary peritoneal CA; use w/ topotecan
unresectable or metastatic hepatocellular CA, first-line tx (off-label)
- [15 mg/kg/dose IV x1 on day 1 of 21-day cycle]
- Info: use w/ atezolizumab
age-related macular degeneration, neovascular (off-label)
- [1.25 mg intravitreally qmo]
- Info: may decr. to 1.25 mg intravitreally x1 prn after 3 doses
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- ovarian CA w/ recto-sigmoid involvement
- ovarian CA w/ bowel involvement
- HTN, uncontrolled
- hemorrhage, severe
- hemoptysis, recent
- GI perforation
- fistula
- surgical wound, unhealed
- major surgery w/in prior 28 days
- avoid: tx for at least 28 days before elective surgery
- avoid: breastfeeding during tx and x6mo after D/C (oncologic use)
- caution: anthracycline use hx
- caution: pelvic XRT hx
- caution: pts of childbearing potential
- caution: pts 65 yo and older
- caution: proteinuria
- caution: thromboembolism hx
- caution: variceal bleeding
- caution: variceal bleeding hx
- caution: bleeding risk
- caution: CHF
- caution: diabetes mellitus
Drug Interactions .
Overview
bevacizumab
VEGF directed antibody
- antiplatelet/anticoagulant effects
- cardiotoxic effects
- GI mucosal injury/bleeding risk
- hypertensive effects
- immunosuppressive oncologic agent
- myelosuppressive oncologic agent
- nephrotoxicity
- thrombogenic effects
Contraindicated
- cidofovir
Avoid/Use Alternative
- adenovirus vaccine, live
- amikacin
- amikacin inhaled
- chikungunya vaccine, live
- chloramphenicol
- cholera vaccine, live
- cladribine oral
- clofarabine
- deferiprone
- dengue vaccine, live
- dexrazoxane
- epinephrine inhaled
- epirubicin
- fexinidazole
- foscarnet
- furosemide
- ganciclovir
- gentamicin
- idarubicin
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- methotrexate
- midodrine
- naloxegol
- palifermin
- penicillamine
- pentamidine
- polymyxin B
- primaquine
- radium Ra 223 dichloride
- ropeginterferon alfa-2b
- rotavirus vaccine, live
- smallpox vaccine, live
- streptomycin
- streptozocin
- tenofovir disoproxil
- tobramycin
- tobramycin inhaled
- tranexamic acid
- typhoid vaccine, live
- vaccinia immune globulin
- valganciclovir
- varicella vaccine, live
- yellow fever vaccine, live
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- abrocitinib
- acalabrutinib
- acebutolol
- acyclovir
- adalimumab
- adefovir dipivoxil
- ado-trastuzumab emtansine
- afatinib
- aflibercept
- albendazole
- albuterol
- albuterol inhaled
- aldesleukin
- alectinib
- alemtuzumab
- alendronate
- aliskiren
- allopurinol
- almotriptan
- alogliptin
- alteplase
- amiloride
- aminocaproic acid
- amlodipine
- amphetamine
- amphotericin
- anacaulase topical
- anagrelide
- angiotensin II
- anthrax immune globulin
- anti-inhibitor coagulant complex
- anti-thymocyte globulin
- antihemophilic factor (factor VIII)/von Willebrand factor complex
- antithrombin
- apixaban
- aprocitentan
- arformoterol inhaled
- argatroban
- armodafinil
- asciminib
- asenapine
- asparaginase
- aspirin
- atenolol
- atidarsagene autotemcel
- atogepant
- atomoxetine
- atropine ophthalmic
- auranofin
- avapritinib
- avatrombopag
- avelumab
- axitinib
- azathioprine
- azilsartan medoxomil
- balsalazide
- baricitinib
- bazedoxifene
- benazepril
- benznidazole
- benzphetamine
- betamethasone
- betaxolol
- betibeglogene autotemcel
- bezlotoxumab
- binimetinib
- bismuth subsalicylate
- bisoprolol
- bivalirudin
- bleomycin
- bortezomib
- bosutinib
- botulism immune globulin
- brentuximab vedotin
- brigatinib
- brolucizumab
- bromelain
- bromfenac ophthalmic
- budesonide
- bumetanide
- bupropion
- C1 esterase inhibitor
- cabazitaxel
- cabozantinib
- caffeine
- caffeine citrate
- calaspargase
- candesartan cilexetil
- cangrelor
- cannabis
- capecitabine
- caplacizumab
- captopril
- carboplatin
- carfilzomib
- carvedilol
- celecoxib
- certolizumab pegol
- chlorothiazide
- chlorthalidone
- chorionic gonadotropin
- cilostazol
- cinacalcet
- cisplatin
- citalopram
- clevidipine
- clindamycin
- clonidine
- clopidogrel
- clozapine
- coagulation factor IX
- coagulation factor VIIa
- coagulation factor XIII A-subunit
- cobimetinib
- cocaine
- colchicine
- colistimethate
- collagenase clostridium histolyticum
- concizumab
- copanlisib
- corticotropin
- cortisone
- creatine
- cyclophosphamide
- cyclosporine
- cysteamine
- cytomegalovirus immune globulin
- dabigatran
- dabrafenib
- dalteparin
- danazol
- danshen
- dapsone
- darbepoetin alfa
- dasatinib
- daunorubicin
- deferasirox
- deferoxamine
- defibrotide
- deflazacort
- desmopressin
- desogestrel (contraceptive)
- desvenlafaxine
- deuruxolitinib
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- dienogest (contraceptive)
- diethylpropion
- diflunisal
- dihydroergotamine
- diltiazem
- dimethyl fumarate
- diosmin
- dipyridamole
- diroximel fumarate
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- doxorubicin
- dronabinol
- dronedarone
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- droxidopa
- duloxetine
- ebola vaccine, live
- edoxaban
- efbemalenograstim alfa
- eflapegrastim (G-CSF)
- eletriptan
- elivaldogene autotemcel
- eltrombopag
- enalapril
- enalaprilat
- encorafenib
- enoxaparin
- entrectinib
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- epoprostenol
- eptifibatide
- eptinezumab
- erenumab
- ergotamine
- erlotinib
- escitalopram
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- etanercept
- etelcalcetide
- ethacrynic acid
- ethanol
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethynodiol (contraceptive)
- etodolac
- etonogestrel (contraceptive)
- etrasimod
- evening primrose oil
- everolimus
- exagamglogene autotemcel
- factor XIII concentrate
- fam-trastuzumab deruxtecan
- faricimab
- fedratinib
- felodipine
- fenfluramine
- fenofibrate
- fenofibric acid
- fenoldopam
- fenoprofen
- fenugreek
- filgrastim (G-CSF)
- fingolimod
- fitusiran
- flucytosine
- fludrocortisone
- fluorouracil
- fluoxetine
- fluphenazine
- flurbiprofen
- flurbiprofen ophthalmic
- fluvoxamine
- follitropin
- fondaparinux
- formoterol inhaled
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galantamine
- galcanezumab
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- givinostat
- golimumab
- guanfacine
- heparin
- hepatitis B immune globulin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxychloroquine
- hydroxyurea
- ibandronate
- ibrutinib
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- ifosfamide
- iloperidone
- iloprost inhaled
- imatinib
- immune globulin
- indapamide
- indomethacin
- infliximab
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- iohexol
- iomeprol
- iopamidol
- irbesartan
- isradipine
- itraconazole
- ketamine
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- labetalol
- lanreotide
- lanthanum
- lapatinib
- lazertinib
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levomilnacipran
- levonorgestrel (contraceptive)
- levonorgestrel (hormone replacement)
- licorice
- lifileucel
- linagliptin
- linezolid
- lisdexamfetamine
- lisinopril
- lithium
- lonafarnib
- lorlatinib
- losartan
- lovotibeglogene autotemcel
- lumacaftor/ivacaftor
- lumateperone
- luspatercept
- lusutrombopag
- lutetium Lu 177 vipivotide tetraxetan
- lymphocyte immune globulin, anti-thymocyte globulin
- magnesium salicylate
- margetuximab
- mavacamten
- meclofenamate
- medroxyprogesterone (contraceptive)
- medroxyprogesterone (hormone replacement)
- mefenamic acid
- megestrol
- meloxicam
- menotropins
- mercaptopurine
- mesalamine
- mesalamine rectal
- methamphetamine
- methoxy polyethylene glycol-epoetin beta
- methyl salicylate topical
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- milnacipran
- minoxidil
- mirabegron
- mirdametinib
- mitomycin
- mitotane
- mitoxantrone
- mobocertinib
- modafinil
- moexipril
- momelotinib
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nadolol
- naproxen
- naratriptan
- nattokinase
- naxitamab
- nebivolol
- necitumumab
- neomycin
- nepafenac ophthalmic
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nisoldipine
- norelgestromin (contraceptive)
- norepinephrine
- norethindrone (contraceptive)
- norethindrone acetate (hormone replacement)
- norgestimate (contraceptive)
- norgestimate (hormone replacement)
- norgestrel (contraceptive)
- nusinersen
- olaparib
- olmesartan medoxomil
- olodaterol inhaled
- olsalazine
- omega-3-acid
- osilodrostat
- osimertinib
- ospemifene
- oxaliplatin
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pacritinib
- pamidronate
- paromomycin
- paroxetine
- pazopanib
- pegaspargase
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- peginterferon beta 1a
- pemetrexed
- penicillin G
- pentosan polysulfate sodium
- pentostatin
- pentoxifylline
- perindopril
- pertuzumab
- pexidartinib
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- pioglitazone
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- plazomicin
- pomalidomide
- ponatinib
- ponesimod
- porfimer
- pralsetinib
- prasugrel
- prazosin
- prednisolone
- prednisone
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- proguanil
- propafenone
- propranolol
- prothrombin complex concentrate (human)
- pseudoephedrine
- pyridostigmine
- pyrimethamine
- quetiapine
- quinapril
- raloxifene
- ramipril
- ramucirumab
- ranibizumab
- regorafenib
- resveratrol
- reteplase
- revakinagene taroretcel
- Rho(D) immune globulin
- ribavirin
- rifabutin
- rimegepant
- ripretinib
- risedronate
- ritlecitinib
- rituximab
- rivaroxaban
- rivastigmine
- rizatriptan
- romiplostim
- ropinirole
- rosiglitazone
- rotigotine transdermal
- ruxolitinib
- ruxolitinib topical
- salmeterol inhaled
- salsalate
- sargramostim (GM-CSF)
- sarilumab
- satralizumab
- saw palmetto
- saxagliptin
- segesterone (contraceptive)
- selpercatinib
- selumetinib
- sertraline
- siponimod
- sipuleucel-T
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- smallpox/mpox vaccine, live
- sodium tetradecyl sulfate
- solriamfetol
- sorafenib
- sotatercept
- sparsentan
- spironolactone
- stiripentol
- succimer
- sulfasalazine
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tagraxofusp
- tamoxifen
- telavancin
- telmisartan
- temsirolimus
- tenecteplase
- tenofovir alafenamide
- teplizumab
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thalidomide
- ticagrelor
- timolol
- tiopronin
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tocilizumab
- tofacitinib
- tolmetin
- toremifene
- torsemide
- tovorafenib
- trabectedin
- trametinib
- trandolapril
- trastuzumab
- trazodone
- treprostinil
- tretinoin
- triamcinolone
- triamterene
- trimethoprim
- ubrogepant
- upadacitinib
- vadadustat
- valacyclovir
- valoctocogene roxaparvovec
- valproic acid
- valsartan
- vamorolone
- vancomycin
- vandetanib
- varicella zoster immune globulin
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- vilazodone
- viloxazine
- vinpocetine
- voclosporin
- von Willebrand factor
- vorapaxar
- vorinostat
- vortioxetine
- warfarin
- willow bark
- yohimbe
- zanidatamab
- zanubrutinib
- zavegepant
- zenocutuzumab
- zidovudine
- ziv-aflibercept
- zoledronic acid
- zolmitriptan
Adverse Reactions .
Serious Reactions
- hemorrhage, severe
- GI perforation
- intestinal necrosis
- impaired wound healing
- fistula formation
- necrotizing fasciitis
- HTN
- angina
- MI
- stroke
- arterial aneurysm
- arterial dissection
- arterial rupture
- arterial thromboembolism
- venous thromboembolism
- CHF
- syncope
- renal injury
- nephrotic syndrome
- thrombotic microangiopathy
- thrombocytopenia
- neutropenia
- febrile neutropenia
- infection, severe
- diarrhea, severe
- posterior reversible encephalopathy syndrome
- sensory neuropathy
- osteonecrosis, jaw
- ovarian failure
- exfoliative dermatitis
- infusion rxn, severe
- anaphylaxis
Common Reactions
- fatigue
- diarrhea
- nausea
- HTN
- epistaxis
- headache
- arthralgia
- dyspnea
- stomatitis
- pain
- anorexia
- dysphonia
- proteinuria
- muscular weakness
- neutropenia
- weight loss
- cough
- myalgia
- hyperglycemia
- back pain
- thrombocytopenia
- hypomagnesemia
- abdominal pain
- vomiting
- rhinitis
- dizziness
- hyponatremia
- Cr incr.
- exfoliative dermatitis
- hypoalbuminemia
- thromboembolism
- mucositis
- sinusitis
- dysgeusia
- xeroderma
- rectal hemorrhage
- lacrimation disorder
- nasal septal perforation
Safety/Monitoring .
Monitoring Parameters
BP q2-3wk; urinalysis; varices eval. w/in 6mo of tx start in pts w/ HCC
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; possible risk of teratogenicity and spontaneous abortion based on limited human data and drug's mechanism of action; risk of fetal harm, incl. teratogenicity, embryo-fetal death, and decr. fetal wt, based on animal data at 1-10x recommended human dose
Individuals of Reproductive Potential
avoid pregnancy by using effective contraception during tx and x6mo after D/C in pts of childbearing potential
Lactation
Clinical Summary
Intravitreal Use: weigh risk/benefit while breastfeeding; inadequate human data available, though risk of infant harm and adverse effects on milk production not expected based on minimal systemic absorption in breastfeeding pts and drug properties
All Other Uses: avoid breastfeeding during tx and x6mo after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: unknown; CYP450: unknown
Excretion: unknown; Half-life: 20 days
Subclass: Antineoplastics, Ophthalmic ; Immunotherapy, VEGF Inhibitors ; Macular Diseases ; VEGF Antagonists ; VEGF Inhibitors, Ophthalmic
Mechanism of Action
binds and inhibits vascular endothelial growth factor (VEGF), resulting in decr. angiogenesis, tumor growth, and cancer progression
Formulary .
No Formulary Selected
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