Bevacizumab

Grey

Brand Name(s):Avastin

Indication: Cancer -breast (metastatic treatment)

Rationale:1

Considered:Sep-12

Review Date:Apr-22

Comments:
NICE CG164 Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer
Updated March 2017
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NICE CG164 Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer
Updated March 2017
1.1 Bevacizumab in combination with capecitabine is not recommended within its marketing authorisation for the first-line treatment of metastatic breast cancer, that is, when treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate, or when taxanes or anthracyclines have been used as part of adjuvant treatment within the past 12 months.

1.2 People currently receiving bevacizumab in combination with capecitabine that is not recommended according to 1.1 should have the option to continue treatment until they and their clinician consider it appropriate to stop.

NICE TA 263 August 2012

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Advice for healthcare professionals:

* Treatment with bevacizumab or sunitinib may be a risk factor for the development of ONJ
* Patients treated who have previously received, or are treated concurrently with, bisphosphonates may be particularly at risk
* Dental examination and appropriate preventive dentistry should be considered before treatment with bevacizumab or sunitinib. Invasive dental procedures should be avoided, if possible, in patients treated with bevacizumab or sunitinib who have previously received, or who are receiving, intravenous bisphosphonates
MHRA Drug safety update Volume 4 Issue 6 January 2011

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Roche Products Limited would like to inform you of an important update to the safety information regarding the use of AVASTIN (bevacizumab).

Cases of osteonecrosis of the jaw (ONJ) have been reported in cancer patients in association with Avastin treatment, the majority of whom had received prior or concomitant treatment with i.v. bisphosphonates.

Avastin treatment may be an additional risk factor for the development of osteonecrosis of the jaw.

This potential risk should be particularly considered when Avastin and bisphosphonates are administered simultaneously or sequentially.

Dental examination and appropriate preventitive dentistry should be considered prior to treatment with Avastin. In patients who have previously received or are receiving i.v. bisphosphonates invasive dental procedures should be avoided, if possible.
Osteonecrosis of the jaw in cancer patients in association with bevacizumab, Avastin and concomitant or previous use of bisphosphonates MHRA November 2010

Healthcare professionals are advised to be aware that infusion reactions and hypersensitivity reactions have been reported commonly (?1/100–<1/10) during treatment with Avastin. The incidence of such reactions is estimated to be up to 5% in clinical trials. Symptoms reported have included dyspnoea, flushing, rash, hypotension or hypertension, oxygen desaturation, chest pain, rigors, and nausea or vomiting. These reactions normally resolve quickly if the infusion is stopped immediately. Treatment with corticosteroids, antihistamines, oxygen, and intravenous fluids may also be administered as clinically indicated. MHRA Drug Safety Update Volume 3 Issue 11 June 2010