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American Journal of Health-System Pharmacy, Vol. 66, Issue 11, 999-1013
Copyright © 2009. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Clinical Review

Understanding and managing the possible adverse effects associated with bevacizumab

Stacy S. Shord, Linda R. Bressler, Lauryn A. Tierney, Sandra Cuellar and Amina George

STACY S. SHORD, PHARMD., BCOP, is Assistant Professor, Department of Pharmacy Practice; LINDA R. BRESSLER, PHARM.D., BCOP, is Clinical Associate Professor, Department of Pharmacy Practice; LAURYN A. TIERNEY is a student; SANDRA CUELLAR, PHARM.D, BCOP, is Clinical Assistant Professor, Department of Pharmacy Practice; and AMINA GEORGE is a student, College of Pharmacy, University of Illinois at Chicago, Chicago.

Address correspondence to Dr. Shord at the College of Pharmacy (M/C 886), Room 164, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612 (sshord{at}uic.edu).

Purpose. The adverse events associated with bevacizumab therapy are characterized, and the underlying pathophysiology, risk factors, frequency, and management of these events are described. Summary. 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. Conclusion. 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. Index terms: Antibodies; Bevacizumab; Hypertension; Toxicity

 

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