Understanding and managing the possible adverse effects associated with bevacizumab

• Published in: American journal of health-system pharmacy Vol. 66; no. 11; pp. 999 - 1013
• Main Authors: Shord, Stacy S, Bressler, Linda R, Tierney, Lauryn A, Cuellar, Sandra, George, Amina
• Format: Journal Article
• Language: English
• Published: England American Society of Health-System Pharmacists 01-06-2009; Oxford University Press
• Subjects: Adverse and side effects; Angiogenesis Inhibitors - adverse effects; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized; Bevacizumab; Drugs; Exanthema - chemically induced; Exanthema - drug therapy; Hemorrhage - chemically induced; Hemorrhage - drug therapy; Humans; Hypertension; Hypertension - chemically induced; Hypertension - drug therapy; Intestinal Perforation - chemically induced; Intestinal Perforation - drug therapy; Posterior Leukoencephalopathy Syndrome - chemically induced; Posterior Leukoencephalopathy Syndrome - drug therapy; Prevention; Proteinuria - chemically induced; Proteinuria - drug therapy; Risk factors; Thromboembolism - chemically induced; Thromboembolism - drug therapy; Wound Healing - drug effects; United States
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp080455

The adverse events associated with bevacizumab therapy are characterized, and the underlying pathophysiology, risk factors, frequency, and management of these events are described.
The adverse events associated with bevacizumab include hypertension, proteinuria, thromboembolism, impaired wound healing, bleeding, perforation, reversible leukoencephalopathy syndrome, skin rash, and infusion-related hypersensitivity reactions. Patients should be monitored for these events throughout the course of bevacizumab therapy. Hypertension is by far the most common adverse event associated with bevacizumab. Blood pressure should be routinely monitored, and hypertension should be medically managed with antihypertensive drugs as deemed appropriate during bevacizumab therapy. Patients should be monitored for proteinuria every three to four weeks, and bevacizumab should be discontinued with persistent proteinuria of >2+. Thromboembolic events, impaired wound healing, bowel and nasal septum perforation, and bleeding share similar pathophysiology. Thromboembolic events should be managed in accordance with guidelines established by the American College of Chest Physicians, and bevacizumab should be discontinued for new life-threatening venous or arterial thromboembolism. To minimize the risk of bleeding or impaired wound healing, bevacizumab should be started at least four weeks after surgery or discontinued for at least six to eight weeks before elective surgery. The management of other adverse events is more anecdotal, with relatively few reports of their occurrence with bevacizumab.
Many of the potential serious complications of bevacizumab can be averted by close monitoring of patient-specific variables, which should be measured at baseline and then at predetermined intervals throughout the course of therapy to maximize patient safety.