How to correctly exert the efficacy of bevacizumab, you and I need to know

As an anti-angiogenic drug, bevacizumab can inhibit tumor neovascularization, improve tumor microenvironment, and increase the sensitivity
of chemotherapy drugs.
So far, it has been confirmed that it is combined with chemotherapy, targeting, immunity and other therapeutic methods, and the dose adjustment has excellent tumor inhibition effect! Bevacizumab itself is a recombinant humanized immunoglobulin G1 monoclonal antibody, which can inhibit tumor growth by inhibiting vascular endothelial growth factor (VEGF) activity and anti-angiogenesis
.
8 major indications and dosage of bevacizumab

In 2004, Roche Avastin was first approved in the United States for the treatment of advanced colorectal cancer, making it the first anti-angiogenic therapy
widely used to treat patients with advanced cancer.

At present, bevacizumab (Avastin) has been approved for 8 major indications in China, respectively

#: Bevacizumab has been approved in combination with paclitaxel and cisplatin or topotecan for the treatment of recurrent, persistent, or metastatic cervical cancer
.

The recommended dose is 15 mg/kg, q3 w; The drug is continued until disease progression or intolerable toxicity
.

# Metastatic colorectal cancer: bevacizumab is a first- or second-line treatment for metastatic colorectal cancer in combination with fluorouracil (FU)-based chemotherapy
.

The recommended dose is 5 mg/kg body weight every two weeks (5 mg/kg/q2 w) or 7.
5 mg/kg body weight every three weeks (7.
5 mg/kg/q3 w) for combination chemotherapy; The drug is continued until disease progression or intolerable toxicity
.

# Recurrent glioblastoma: bevacizumab has been approved as monotherapy
for patients with progressive glioblastoma after previous treatment.

The recommended dose for intravenous bevacizumab is 10 mg/kg body weight, administered every two weeks (10 mg/kg/q2w); The drug is continued until disease progression or intolerable toxicity
.

#/metastatic or recurrent non-small cell lung cancer (NSCLC): bevacizumab is a combination of carboplatin and paclitaxel for the first-line treatment of
recurrent, locally advanced, unresectable, or metastatic non-squamous non-small cell lung cancer.

The recommended dose of bevacizumab is 15 mg/kg body weight every 3 weeks (15 mg/kg/q3 W); Bevacizumab in combination with platinum-based chemotherapy is given for up to 6 cycles, followed by bevacizumab monotherapy until disease progression or intolerable toxicity
.

# Epithelial ovarian, fallopian tube, or primary peritoneal cancer: bevacizumab has approved chemotherapy regimens for platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer with carboplatin, or in combination with paclitaxel, doxorubicin, or topotecan for platinum-resistant diseases
.

Stage III/IV disease after initial surgical resection: the recommended dose of bevacizumab is 15 mg/kg once every 3 weeks (15 mg/kg/q3w), combined with paclitaxel + carboplatin chemotherapy regimen for up to 6 cycles, followed by bevacizumab alone 15 mg/kg/q3w; The total medication time of this drug is up to 22 cycles or continuous use until the disease progresses, whichever occurs first;

Platinum-resistant

A.
The recommended dose of bevacizumab is 10mg/kg q2w at a time, in combination with any of the following chemotherapy drugs: paclitaxel, pegylated doxorubicin liposomes, topotecan (q1w);

B.
Bevacizumab 15mg/kg q3w at a time, combined with topotecan (q3w).

Platinum sensitive

A.
Bevacizumab 15mg/kg q3w once, combined with carboplatin + paclitaxel for 6-8 cycles, followed by monotherapy, 15mg/kg q3w once, continue until disease progression;

B.
Bevacizumab 15mg/kg q3w once, combined with carboplatin + gemcitabine for 6-10 cycles, followed by monotherapy, 15mg/kg q3w once, continue until disease progression

# Hepatocellular carcinoma (HCC): bevacizumab in combination with atezolizumab is used to treat patients
with unresectable metastatic hepatocellular carcinoma.

After combined with atezolizumab 1200 mg, intravenous infusion of bevacizumab 15 mg/kg, q3w; The drug is continued until disease progression or intolerable toxicity
.

Minor questions about bevacizumab

ask

Does bevacizumab enter the national medical insurance policy?

answer

From January 1, 2022, the new version of the National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance Drug Catalogue (2021 Edition) (the "National Medical Insurance Catalogue") has been officially implemented
.
According to the provisions, bevacizumab was changed from a national direct negotiation variety to a basic medical insurance category B variety
.
In addition to the previous first-line NSCLC and advanced metastatic colorectal cancer indications, bevacizumab also adds first-line indications for liver cancer and brain glioma, which are indications that can be reimbursed by medical insurance
.

ask

How do people with hypertension use bevacizumab?

answer

Antihypertensive therapy is recommended in patients with hypertension or a significantly elevated baseline hypertension, and early initiation of antihypertensive therapy has been shown to reduce complications, even in life-threatening encephalopathy with continued bevacizumab therapy to prevent or reduce hypertension
.
However, it should be discontinued in patients with uncontrolled severe hypertension, such as hypertensive crisis or hypertensive encephalopathy
.
After stopping bevacizumab, blood pressure usually returns to pre-treatment levels
.

ask

What should I do if protein in the urine occurs during use?

answer

In addition to hypertension, proteinuria is a side effect
associated with the mechanism of action of bevacizumab.
In fact, only 3% of patients will stop the drug permanently because of proteinuria, so the phenomenon of proteinuria is mostly controllable
.

If proteinuria occurs during medication, medication needs to be adjusted according to different
grades.
urine protein 1+ to 3+ or 24-hour urine protein <2 g, continue to give antiangiogenic drugs according to the predetermined protocol; urine protein 4+ or 24-hour urine protein ≥2g, suspend this dosing plan, postpone the administration until 24-hour urine protein <2g; Grade 4 proteinuria (nephrotic syndrome) is permanently discontinued<b11>.