Page 1 INTRAVENOUS CANCER TREATMENT EDUCATION THP PACLITAXEL + BEVACIZUMAB PACLITAXEL + BEVACIZUMAB Name of the regimen and cancer drugs Your care team may refer to your treatment as “Taxol-Avastin”. The regimen consists of 2 different chemotherapies: • Paclitaxel (PA klih TAK sil): Taxol® • Bevacizumab (beh vuh SIH zoo mab): Avastin ®, Mvasi ®, Zirabev ® Common uses This regimen is most commonly used to treat ovarian, fallopian tube, or primary peritoneal cancer. It may also be used for other treatments. Treatment schedule Your treatment will be given into your vein through an intravenous (IV) line. This may be into a short, flexible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line is a long, flexible IV tube that empties into a very large vein next to the heart. Talk with your care team to see which will be best for you and your treatment. Each Taxol-Avastin treatment is repeated every 28 days. This is known as one cycle. Your treatment may be given for a set number of cycles, or it will keep going until the drug, or drugs, stop working or you have side effects which stop you from continuing treatment. o Paclitaxel IV is given on days 1, 8, 15, and 22. o Bevacizumab IV is given on days 1 and 15. Other medications Other medications may be ordered for you to prevent or treat certain side effects. These include: Instructions: Anti-nausea medications You will receive medications to prevent nausea just before your cancer treatment. You may also get prescriptions for other medications to take at home, as below: Medications to prevent allergic reactions You will receive medications to prevent infusion related reactions prior to starting your cancer treatment. Drug Cycle 1 Day 1 2 3 ... 8 ... 15 ... 22 ... 28 Cycle 2 Day 1 Paclitaxel Bevacizumab Page 2 PACLITAXEL + BEVACIZUMAB INTRAVENOUS CANCER TREATMENT EDUCATION Possible drug interactions o Paclitaxel and bevacizumab may interact with other drugs you are taking. Please inform your care providers of all prescription medicine, over-the-counter medications, vitamins, and herbal products that you take. o Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Common Side Effects Common side effects that have been known to happen in patients receiving paclitaxel and bevacizumab are listed in the left side of this table. In some instances, the side effects may be reported less often but are still important to discuss. This table does not list all the known side effects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side effect of a drug; even if you are taking the same drug as another patient, you may experience different side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infections. • Bathe often for good personal hygiene. Contact your care team if you experience any signs or symptoms of an infection such as: • Fever (temperature more than 100.4°F or 38°C) • Chills • Sore throat • Burning when peeing • Tiredness that is worse than normal • A sore that becomes red, is draining, or does not heal. Check with your care team before taking any medicine for a fever or chills. Continued on the next page Page 3 INTRAVENOUS CANCER TREATMENT EDUCATION THP PACLITAXEL + BEVACIZUMAB Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. • Use caution to avoid bruises, cuts, or burns. • Blow your nose gently and do not pick your nose • Brush your teeth gently with a soft toothbrush and maintain good oral hygiene • When shaving use an electric razor instead of razor blades • Use a nail file instead of a nail clippers Call your care team if you have bleeding that won’t stop. Examples include: • A bloody nose that bleeds for more than 5 minutes despite pressure • A cut that continues to ooze despite pressure • Gums that bleed a lot when you floss or brush Seek medical help right away if you have any severe headaches, blood in your urine or stool, coughing up blood, or bleeding that you cannot stop or lasts a long time. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care team or dentist before any scheduled procedures. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be checked by a simple blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. • Try to get 7 to 8 hours of sleep per night • Avoid operating heavy machinery if you feel too tired • Find a balance between “work” and “rest” • Stay as active as possible, but know that it is okay to rest as needed, too • You might notice that you are more pale than usual Let your care team know right away if you have: • Shortness of breath • Dizziness • Fast or abnormal heartbeat Continued on the next page Page 4 PACLITAXEL + BEVACIZUMAB INTRAVENOUS CANCER TREATMENT EDUCATION Possible Side Effect Management Fatigue • You may be more tired than usual or have less energy • Stay as active as possible, but know it is okay to rest as needed • Try to do some type of moderate activity every day • Conserve your energy. Plan your activities and do them at a time of day when you feel a bit more energetic • Follow a healthy diet and stay hydrated • Accept help from family and friends • Find healthy ways to manage stress, such as meditation, journaling, yoga, and guided imagery • Develop good sleeping habits, limit napping during the day to help you sleep better at night • Avoid operating heavy machinery if you feel too tired • Contact your care team if you experience extreme fatigue that prevents you from doing your normal daily activities Increased blood pressure Take your blood pressure often. Record your blood pressure in a diary and report these to your care team. Contact your care team for high blood pressure or if the following symptoms occur: • Headache • Dizziness • Chest pain • Shortness of breath • Fluid retention, weight gain, or swelling Decreased appetite Talk to your care team if you notice weight loss while taking this medication. When you do not feel like eating, try: • Small frequent meals instead of 3 large meals each day • Keep snacks nearby so you can eat when you feel hungry • Liquid nutritional supplements • Drink 8-10 glasses of water or fluid each day, especially if you are not eating, unless your care team has instructed you to limit your fluid intake Numbness or tingling in hands and feet • Report changes to your sense of touch, such as a burning feeling, pain on the skin or weakness. Hair loss (alopecia) • Hair will likely grow back after treatment is completed, although the color and/or texture may be different. • It may take 3 to 6 months after therapy is completed to resume normal hair growth. • Some people choose to wear scarves, caps, or wigs. A short haircut prior to treatment may help with stress of hair loss. • Partial or complete hair loss is likely, usually 1-2 weeks after start of therapy. This hair loss can be all body hair. • Be sure to keep your head covered to protect it from the sun during the summer and cold during the winter. Continued on the next page Page 5 INTRAVENOUS CANCER TREATMENT EDUCATION THP PACLITAXEL + BEVACIZUMAB Possible Side Effect Management Hair loss (alopecia) (continued) • If not covering your scalp during the summer months, be sure to use sunscreen when spending time outdoors. Muscle or joint pain or weakness • Keep a diary of your pain including when and where the pain happens, what it feels like, and how long it lasts • Stay as active as possible, but know that it is okay to rest as needed, too • Tell your care team if pain limits what you can do If the pain or weakness bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care team. Mouth irritation or sores (stomatitis or mucositis) Practice good mouth care. • Rinse your mouth after meals and at bedtime, and more frequently if you develop sores in your mouth • Brush your teeth with a soft toothbrush or cotton swab after meals • Use a mild non-alcohol mouth rinse at least 4 times a day (after eating and at bedtime). One example is a mixture of 1/8 teaspoon of salt and 1/4 teaspoon of baking soda in 8 ounces of warm (not hot) water • Avoid acidic, hot or spicy foods and beverages, and rough foods that might irritate the mouth • If you have sores in your mouth, avoid using tobacco products, alcohol, and mouthwashes that contain alcohol Call your care team if you experience pain or sores in your mouth or throat. Nausea or vomiting • Take all medications as prescribed to help prevent and lessen symptoms of nausea and vomiting. • Eat and drink slowly. • Drink 8-10 (8-ounce) glasses of water and/or fluid (soup or broth) each day unless your care team has instructed you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland foods; avoid spicy, fried, and greasy foods. • Avoid intense exercise immediately after eating. • Don’t lay down right away after eating. • Wear loose fitting clothing for comfort. • Avoid strong odors. Consider getting fresh air and try deep breathing. Let your care team know if you have nausea or vomiting. Your care team may prescribe medication to help with the symptoms. Continued on the next page Page 6 PACLITAXEL + BEVACIZUMAB INTRAVENOUS CANCER TREATMENT EDUCATION Possible Side Effect Management Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day. • Drink 8-10 (8-ounce) glasses of water or fluid each day unless your care team has asked you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low-fiber foods (such as bananas, applesauce, potatoes, chicken, rice, and toast). • Avoid high fiber foods, such as raw vegetables and fruits and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid foods with lactose, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your care team if: • The number of bowel movements you have in a day increases by 4 or more. • You feel dizzy or lightheaded. Your care team may recommend an over-the-counter medication or prescribe something to help manage your symptoms. Nail changes • Nails on fingers and toes may look swollen and reddened and may grow ridges. • Skin/Nail changes: report any rashes, dryness or scaling to care provider, use mild soaps and rinse well, avoid hot water, use alcohol free oil-based moisturizers, report any darkening or peeling skin or any changes to the nail. • Usually, this change starts at the cuticle and may affect the skin around the nail • Wear gloves when cleaning or doing dishes, or working in the garden • Keep nails trimmed and hands clean • Biting, chewing, or picking at your nails can increase the risk of getting an infection • Talk to your care team if you notice any changes in your nails Rare but serious side effects Tell your care provider if you experience any symptoms of these problems: o If you need to have a surgical or dental procedure, tell your doctor that you are taking bevacizumab. Bevacizumab may need to be stopped until your wound heals after some types of surgery. o You may be at a higher risk of bleeding while taking bevacizumab. Be sure to seek medical attention right away if you have any major bleeding. Also be sure to check for any signs of bleeding in your stool. o Tell your doctor right away if you get high fever, nausea, vomiting, severe abdominal pain. o Bevacizumab may cause a tear or hole in your stomach or intestines. If you experience severe abdominal pain, nausea, constipation, or vomiting, please contact your care team immediately. o Bevacizumab may be harmful to your kidneys. Speak to your care team to know when you need to have laboratory tests done to monitor your kidneys. Page 7 INTRAVENOUS CANCER TREATMENT EDUCATION THP PACLITAXEL + BEVACIZUMAB Rare but serious side effects (continued) o Paclitaxel may be harmful to your liver. Speak to your care team to find out when you need to have blood tests done to monitor your liver function. If you get this side effect, your doctor may change your dose or stop treatment for some time. o Bevacizumab can increase your risk of having a blood clot. o Bevacizumab can cause heart failure. Report symptoms related to swelling and shortness of breath to your care team. o A condition called posterior reversible encephalopathy syndrome (PRES) can occur while taking bevacizumab. Call your care team right away if you have headaches, seizures, confusion, or changes in vision. o Hypersensitivity reaction: Severe allergic reactions are a rare but serious side effect of bevacizumab and paclitaxel. Seek medical attention right away if you notice difficulty breathing, swelling of the mouth or tongue, or a serious rash. o Paclitaxel is an irritant with vesicant-like properties. If it leaks outside of the IV, it can cause severe damage to your skin. Notify your nurse right away if you feel any pain, aching, burning, itching, swelling, or redness at the site of your IV. If you experience ANY new, worsening, or uncontrolled side effects, call your care team immediately. Handling body fluids and waste Some of the drugs you receive may be present in urine, stool, sweat, or vomit for many days after treatment. Many cancer drugs are toxic, your bodily waste may also be toxic and can be dangerous to come into contact with. Once you have started paclitaxel and bevacizumab, follow the instructions below for at least two days after your treatment. This is to keep you, your loved ones, and the environment as safe as possible. o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. o Toilet and septic systems • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure that all waste has been discarded. o If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surface after every use before other people use the toliet. o Wash hands with soap and water after using the toilet for at least 20 seconds. o If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. o If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. o Wash any skin that has been exposed to body waste with soap and water. o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Page 8 PACLITAXEL + BEVACIZUMAB INTRAVENOUS CANCER TREATMENT EDUCATION Intimacy, sexual activity, contraception, and fertility This treatment may cause changes that can affect intimacy and sexuality, including desire and body image. Maintaining physical closeness and/or intimacy with loved ones can be continued during treatment. Holding hands, hugging, and kissing can be done safely. It is recommended that you talk to your care team about any restrictions or questions you may have. Some treatments can influence the ability to have children, also known as fertility. If you’re interested in preserving fertility, talk to your care team before treatment. Ask your healthcare provider to determine when it is safe to become pregnant after your treatment. Patients of reproductive ability should not become pregnant or get their partners pregnant while receiving paclitaxel and bevacizumab. Some of the drugs you receive may be present in semen and vaginal secretion for many days after treatment. You should use barrier devices, such as condoms, during sexual activity to limit exposure to body fluids. o Talk to your care team about birth control. Not all options may be right for your treatment or cancer. Effective contraception could include one or more of the following: barrier methods (e.g. condoms), hormone methods (e.g. birth control pills), or surgery. o Tell your care team if you become pregnant or plan to breastfeed. Additional resources Prescribing information: Paclitaxel: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020262s049lbl.pdf Bevacizumab: https://www.gene.com/download/pdf/avastin_prescribing.pdf Additional instructions Updated – August 28, 2022