For which complications would the nurse monitor in a patient receiving bevacizumab?

Background: Colorectal cancer (CRC) that has metastasized before being discovered, or reoccurs following surgery, remains a major treatment challenge. Trials have established the usefulness of antiangiogenic agents and new regimens in prolonging survival in patients with advanced disease. In the United States, the antiangiogenic agents approved for treating metastatic CRC often are combined with traditional chemotherapeutic agents and include bevacizumab (Avastin®), ziv-aflibercept (Zaltrap®), and regorafenib (Stivarga®).

Objectives: This article reviews factors that guide the development of a nursing plan for monitoring and managing patients who are receiving antiangiogenic therapies.

Methods: Regorafenib and ziv-aflibercept, two newer agents that nurses and other healthcare professionals may have had less experience with, were reviewed.

Findings: The key to maximizing the potential benefit of these agents is understanding where these new therapies fit in the overall scheme of treatment options and how to help patients tolerate treatment.

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Medication Information Leaflet

What is this medication for?

Bevacizumab is used to treat some types of cancer (e.g. colorectal cancer, breast cancer, brain cancer, endometrial cancer, lung cancer and ovarian cancer).

It is a monoclonal antibody which blocks VEGF (Vascular Endothelial Growth Factor), thus preventing the growth of blood vessels which supply oxygen and nutrients to the cancer cells.

How should I take/use this medication?

• Bevacizumab is given as an injection into your vein (intravenous).

What precautions should I take?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.

• You become pregnant or plan for pregnancy

  • You should use effective birth control during treatment and for 6 months after your last treatment.

• You are breastfeeding

  • Do not breastfeed during treatment and for 6 months after your last treatment.

• You are taking any other medications, including supplements, traditional medications and herbal remedies.

• You are going for any surgical procedures (e.g. biopsy, tooth extraction) at least 4 weeks beforehand, as treatment may need to be temporarily stopped.

What are some common side-effects of this medication?

Early Side Effects (within days after receiving Bevacizumab)

• Diarrhea

  • Drink plenty of clear fluids to replace those lost (2 litres everyday).

  • Avoid oily or spicy food and milk or dairy products.

Delayed Side Effects (within days to weeks after receiving Bevacizumab)

• Increased blood pressure that may cause headache, dizziness or changes in vision

  • Monitor your blood pressure regularly and record it down. Inform your doctor if you notice an increasing trend.

• Protein loss in urine

  • Your doctor will arrange for a test to check this for you.

• Increased chances of low blood counts if you are also receiving chemotherapy

• Allergic reactions. Please alert your nurse if you experience this during your treatment. The symptoms of this include one or more of the following:

  • Chills, rigors

  • Facial flushing

  • Swollen face/eyes/lips/tongue

  • Difficulty in breathing

  • Itchy skin rashes over your whole body

• Unusual bleeding or bruising, black sticky stools, coughing up blood, or persistent nosebleeds or gum bleeding

• Signs of blood clot such as painful leg swelling, tenderness or hardness over a vein, sudden onset of cough, shortness of breath, chest pain or stroke symptoms (e.g. sudden onset of severe headache, trouble talking or moving properly, weakness or numbness in arm or leg)

• Wounds that do not heal or are slow to heal

• Very bad stomach pain with nausea or vomiting, fever

If you experience any of these symptoms, you should see your healthcare professional immediately.

You may refer to the following website if you need more information: https://www.macmillan.org.uk/

Disclaimers

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on May 2022

This article was last reviewed on Tuesday, October 4, 2022

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