Main use Active ingredient Manufacturer
Colorectal, breast, lung and kidney cancer Bevacizumab Roche

How does it work?
Avastin infusion contains the active ingredient bevacizumab,which is a type of medicine called a humanised monoclonal antibody. It is usedto treat cancers of the large intestine and rectum (colorectal cancers) andbreast cancers that have spread to other parts of the body. It can also be usedto treat advanced lung cancer and advanced kidney cancer.

In order to grow, cancerous tumours need a blood supply thatprovides the cancer cells with nutrients and oxygen. The growth of the cancertherefore depends on the tumour having a network of blood vessels supplyingit.

Cancerous tumours produce substances called growth factors thatstimulate nearby blood vessels to grow into the tumour. These new blood vesselsallow the cancer cells to grow and multiply and also allow them to spread intoother areas of the body through the blood circulation.

Tumours have been found to produce a particular growth factorcalled vascular endothelial growth factor (VEGF). VEGF stimulates new bloodvessels to grow into the tumour.

Bevacizumab acts by neutralising this VEGF. It works in asimilar way to the natural antibodies produced by our immune system. Ournatural antibodies recognise foreign invaders and bind to them, helping ourimmune systems to attack them and protect us from infections. Monoclonalantibodies like bevacizumab are made in laboratories and can be used to attackparticular proteins in a similar way.

Bevacizumab specifically recognises and binds to the VEGFproduced by the tumour. This makes the VEGF unable to stimulate blood vesselsto grow. As a result, the cancer’s blood supply is reduced and with it, itssupply of oxygen and nutrients. This causes the tumour to shrink, or at leastto stop growing.

Medicines that stop the growth of blood vessels in this way arecalled angiogenesis inhibitors.

As bevacizumab is targeted specifically against the VEGF proteinproduced by the tumour, it has little effect on healthy cells or existing bloodvessels elsewhere in the body.

Bevacizumab is given in combination with chemotherapy treatmentthat directly attacks and kills the cancer cells. To treat colorectal cancer itcan be given with fluoropyrimidine-based chemotherapy such as 5FU(fluorouracil) and folinic acid, irinotecan, capecitabine or oxaliplatin. Totreat breast cancer it is given in combination with paclitaxel. To treat lungcancer it is given in combination with platinum-based chemotherapy. To treatkidney cancer it is given in combination with interferon alfa-2a.

Bevacizumab is given as a drip into a vein (intravenousinfusion) once every two or three weeks. The first dose is administered over 90minutes. If this is well tolerated, the next dose may be given over 60 minutes;if this is also well tolerated all further doses may be given over 30minutes.

What is it used for?
Cancer of the large bowel (colon) and rectum (colorectal cancer) that has spread to other areas of the body.
Breast cancer that has spread to other areas of the body.
Advanced non-small cell lung cancer (NSCLC).
Advanced kidney cancer and/or kidney cancer that has spread to other areas of the body.
Warning!
This medicine may interfere with the wound healing process because it impairs the growth of new blood vessels. For this reason, treatment with this medicine should not be started until at least 28 days after major surgery, or until any wound from surgery is fully healed. If you need to have any operations, treatment with this medicine will need to be interrupted.
Your doctor will need to regularly check your blood pressure and levels of protein in your urine while you are having treatment with this medicine.
This medicine may decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you may need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
This medicine can sometimes cause a blood clot in a vein (DVT) or an artery (which could cause a heart attack or stroke). For this reason, you should let your doctor know immediately if you get any of the following symptoms during treatment: stabbing pains and/or unusual swelling in one leg, pain on breathing or coughing, coughing up blood, sudden breathlessness, sudden severe chest pain, sudden disturbance in vision, hearing or speech, sudden weakness or numbness on one side of the body, fainting or collapse.
Tell your doctor immediately if you experience seizures (fits), headache, confusion or changes in vision during treatment with this medicine.
This medicine may be harmful to an unborn baby. For this reason, women receiving this medicine should use an effective method of contraception to prevent pregnancy, both during treatment and for at least six months after treatment is finished. Women should consult their doctor immediately if they get pregnant.
Use with caution in
People over 65 years of age.
People with inflammation in the gut or abdomen (eg diverticulitis, stomach ulcers, colitis associated with chemotherapy).
History of high blood pressure (hypertension).
Uncontrolled high blood pressure (hypertension).
History of stroke or mini-stroke (transient ischaemic attack).
History of heart attack.
Angina.
Heart failure.
People with blood clotting problems.
People having treatment with anticoagulant medicines for a blood clot.
People who have previously been treated with radiotherapy to the chest or with anthracycline chemotherapy medicines such as doxorubicin.
People who have recently had major surgery or any major wounds.
Not to be used in
Allergy to Chinese hamster ovary (CHO) cell products or other recombinant human or humanised antibodies.
People with tumours that have spread to the brain or spinal cord (central nervous system) and have not been treated.
People who have recently had any bleeding in the lungs or have been coughing up blood.
Pregnancy.
Breastfeeding.
The safety and efficacy of this medicine have not been established in children and adolescents under 18 years of age. It is not recommended for this age group.
This medicine should not be used if you are allergic to one orany of its ingredients. Please inform your doctor or pharmacist if you havepreviously experienced such an allergy.

If you feel you have experienced an allergic reaction, stopusing this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy orbreastfeeding. However, other medicines may be safely used in pregnancy orbreastfeeding providing the benefits to the mother outweigh the risks to theunborn baby. Always inform your doctor if you are pregnant or planning apregnancy, before using any medicine.

This medicine must not be used during pregnancy. It could be harmful to a developing foetus because it stops the formation of new blood cells. Women who could get pregnant must use effective methods of contraception to prevent pregnancy while having treatment with this medicine and for at least six months after the treatment is finished. Seek medical advice from your doctor. Inform your doctor immediately if you think you could be pregnant at any point during treatment.
It is not known if this medicine passes into breast milk. However, as it could harm the development of the infant if it does pass into breast milk; mothers should not breastfeed during treatment with this medicine, or for at least six months after their last dose. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individualpeople in different ways. The following are some of the side effects that areknown to be associated with this medicine. Just because a side effect is statedhere does not mean that all people using this medicine will experience that orany side effect.

Raised blood pressure (hypertension).
Diarrhoea.
Nausea and vomiting.
Feeling of weakness or fatigue.
Decreased number of white blood cells, red blood cells or platelets in the blood.
Feeling of numbness or tingling in hands or feet.
Slow wound healing.
Infections.
Bleeding.
Headache.
Constipation.
Abdominal pain.
Fever.
Pain.
Sore mouth.
Loss of appetite.
Change in taste.
Shortness of breath.
Blood clot in a vein of the leg (deep vein thrombosis).
Blood clot in an artery, causing a heart attack or stroke.
Heart failure.
Formation of holes (perforation) in the wall of the stomach or intestine.
Formation of abnormal tube-like connections between organs that are not normally connected or between an organ and the skin (fistulae).
Protein in the urine, which may be linked to kidney problems.
The side effects listed above may not include all of the sideeffects reported by the drug's manufacturer.

For more information about any other possible risks associatedwith this medicine, please read the information provided with the medicine orconsult your doctor or pharmacist.

How can this medicine affect other medicines?
You should tell your doctor or pharmacist if you are taking anyother medicines, including those bought without a prescription and herbalmedicines, before starting treatment with Avastin. Similarly, you should alsocheck with your doctor or pharmacist before taking any new medicines while youare still receiving treatment with Avastin, so they can check that thecombination issafe.

People who have had treatment with an anthracycline chemotherapymedicine, such as doxorubicin, epirubicin or idarubicin, before startingtreatment with this medicine may have a higher risk of side effects on theheart.

Other medicines containing the same active ingredient
There are currently no other medicines available in the UK thatcontain bevacizumab as the active ingredient.