Page 1 INTRAVENOUS CANCER TREATMENT EDUCATION BEVACIZUMAB Name of the regimen and cancer drugs • Bevacizumab (beh vuh SIH zoo mab): Avastin®, Mvasi®, Zirabev® Common uses Bevacizumab is used to treat patients with the following: • Glioblastoma • Renal cell carcinoma • Cervical cancer • Ovarian, fallopian tube, or primary peritoneal cancer • Hepatocellular carcinoma • Non-small cell lung cancer (NSCLC) Bevacizumab 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, fl exible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line is a long, fl exible 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 bevacizumab treatment is repeated every 14 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 stops working or you have side eff ects which stop you from continuing treatment.  Bevacizumab IV is given on Day 1. Drug DAY 1 2 3 4 5 6 7 8 9 ... 14 Cycle 2 Day 1 Bevacizumab X X Page 2 Other medications Other medications may be ordered for you to prevent or treat certain side eff ects. These include: Possible drug interactions  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.  Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Instructions: Medications to prevent side eff ects You may receive medications to prevent side eff ects just before your cancer treatment. You may also get prescriptions for other medications to take at home as below: Page 3 Common Side Eff ects Common side eff ects that have been known to happen in patients receiving bevacizumab are listed in the left side of this table. In some instances, the side eff ects may be reported less often but are still important to discuss. This table does not list all the known side eff ects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side eff ect of a drug; even if you are taking the same drug as another patient, you may experience diff erent side eff ects. Options to help manage any side eff ects 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 eff ect you cannot manage or that is not listed here, contact your care provider. Possible Side Eff ect 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 a 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 fl uid each day, especially if you are not eating, unless your care team has instructed you to limit your fl uid intake. Continued on the next page Page 4 Rare but serious side eff ects  Infusion reaction: Bevacizumab can rarely cause an infusion reaction. During your treatment, let the nurse know right away if any of these symptoms happen: chills or shaking, dizziness, fever, itchiness or rash, fl ushing, diffi culty breathing, wheezing, sudden back pain, or feeling faint.  Gastrointestinal perforation or fi stula (holes in the gastrointestinal tract or connections in the gastrointestinal tract that are not supposed to be present): Gastrointestinal perforations and fi stulas have been reported in patients treated with bevacizumab. Tell your doctor right away if you experience severe abdominal pain, chills, or fever.  Wound healing problems: Bevacizumab may aff ect how well your wounds heal. If you need to have a surgical or dental procedure, tell your doctor right away that you are taking bevacizumab. Your treatment may need to be stopped several days prior to surgery and held until your wound heals.  Hemorrhage (bleeding): You may be at a higher risk of bleeding while taking bevacizumab. Seek medical attention right away if you have any severe bleeding, such as vomiting or coughing up blood, or bloody diarrhea. Also report bleeding-episodes such as nosebleeds, gums bleeding, or tarry stools.  Venous thromboembolism (blood clot): Contact your care team right away if you notice swelling, redness, or pain in your arms or legs or new shortness of breath or chest pain.  Encephalitis: Bevacizumab may cause infl ammation of the brain. This can be fatal and you should contact your doctor if you are experiencing any symptoms such as: headache, seizure, fever, fatigue, memory issues, sleepiness, hallucinations, or stiff neck.  Renal failure/proteinuria: 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.  Heart failure: Bevacizumab can cause heart failure. Report symptoms related to swelling and shortness of breath to your care team. If you experience ANY new, worsening, or uncontrolled side eff ects, call your care team immediately. (INSTITUTIONAL CONTACT INFO) Page 5 Handling body fl uids 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 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.  Pregnant women should avoid touching anything that may be soiled with body fl uids from the patient.  Toilet and septic systems • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-fl ow toilet, close the lid and fl ush twice to ensure that all waste has been discarded.  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.  Wash hands with soap and water after using the toilet for at least 20 seconds.  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.  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.  Wash any skin that has been exposed to body waste with soap and water.  Linens or clothing that are soiled with body fl uids 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.  Wash hands with soap and water after touching linens or clothing that may be soiled with body fl uids. Intimacy, sexual activity, contraception, and fertility This treatment may cause changes that can aff ect 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 infl uence 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 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 fl uids.  Talk to your care team about birth control. Not all options may be right for your treatment or cancer. Eff ective contraception could include one or more of the following: barrier methods (e.g. condoms), hormone methods (e.g. birth control pills), or surgery.  Tell your care team if you become pregnant or plan to breastfeed. Page 6 Additional resources Product Product website: https://www.avastin.com/hcp.html Prescribing information link: https://www.gene.com/download/pdf/avastin_prescribing.pdf Product resources: https://www.opdivo.com/patient-caregiver-support/patient-resources Additional instructions Updated – December 8, 2021 Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the therapy derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse eff ects, or risks associated with this therapy and should not substitute for the advice of a qualifi ed healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this therapy by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual receiving therapy. All decisions related to receiving this therapy should be made with the guidance and under the direction of a qualifi ed healthcare professional. Permission: Intravenous Cancer Treatment Education (IVE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about intravenous cancer therapy. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2021 by NCODA. All rights reserved.