Bevacizumab is a monoclonal antibody belonging to a class of drugs called anti-angiogenics, used to stop the growth and spread of cancer by stopping the formation of blood vessels that carry oxygen and nutrients to the tumour, thus slowing its growth and spread.
It is a cytotoxic drug that, in addition to attacking the cancer, stops the growth of the blood vessels that feed the cancer. However, it can also cause side effects that are worth knowing about and monitoring.
What is bevacizumab and what is it used for?
Bevacizumab is a monoclonal medicine belonging to a class of medicines called antiangiogenic medicines. It is often used in combination with other medicines to treat certain types of cancer:
- Metastatic colorectal cancer: with fluoropyrimidine-based chemotherapy.
- Metastatic breast cancer: with paclitaxel or capecitabine, depending on the adequacy of other treatments.
- Non-small cell lung cancer: with platinum-based chemotherapy, excluding squamous cell-predominant types.
- Advanced ovarian cancer: with carboplatin and paclitaxel or gemcitabine, depending on stage and relapse.
- Persistent, recurrent or metastatic cervical cancer: with paclitaxel and cisplatin or topotecan.
Bevacizumab directly targets a protein called vascular endothelial growth factor (VEGF), which helps cancer cells develop new blood supplies. By blocking this protein, it stops this development.
Effectiveness of Bevacizumab in cancer treatment
- Metastatic colorectal cancer: bevacizumab, in combination with chemotherapy, can increase overall and progression-free survival. Studies indicate a 19% reduction in deaths and a 35% reduction in disease progression.
- Metastatic breast cancer: the combination of bevacizumab with paclitaxel has been shown to improve response rate and progression-free survival, although its use has been controversial due to side effects and variability in results.
- Advanced/metastatic non-small cell lung cancer: bevacizumab, together with platinum-based chemotherapy, has been shown to improve progression-free survival and response rate in patients with this type of cancer.
- Advanced ovarian cancer: bevacizumab, combined with platinum-based chemotherapy, has improved progression-free survival in patients with advanced ovarian cancer.
- Persistent, recurrent or metastatic cervical cancer: the addition of bevacizumab to standard chemotherapy has been shown to improve overall survival and response rate in patients with advanced cervical cancer.
Factors influencing effectiveness:
- Cancer type and stage: the response to bevacizumab may vary depending on the type of cancer and its stage. For example, its effectiveness in metastatic colorectal cancer may differ from its effectiveness in metastatic breast cancer.
- Combination with other treatments: bevacizumab is used in combination with different chemotherapies, and the choice of these combination treatments may affect its effectiveness. For example, it is combined with paclitaxel for breast cancer and platinum-based chemotherapy for lung cancer.
- Patient characteristics: factors such as age, general health and the presence of other medical conditions may influence the response to bevacizumab treatment.
- Treatment resistance: some patients may develop resistance to bevacizumab, which reduces its effectiveness over time.
- Dosage and administration regimen: the dose and frequency of bevacizumab administration may also influence its effectiveness and the occurrence of side effects.
Bevacizumab side effects
Side effects described:
- High blood pressure: to be monitored and may require treatment with antihypertensive drugs.
- Protein in urine: appearance or increased presence of protein in urine.
- Healing problems: bevacizumab may interfere with wound healing.
Less common side effects:
- Arterial thrombosis: risk of myocardial infarction and stroke.
- Haemorrhagic complications: include severe gastrointestinal and pulmonary haemorrhages.
- Congestive heart failure: especially in patients with a history of heart disease.
- Gastrointestinal perforation: a rare but serious complication that may require surgery.
- Infusion-related reactions: include fever, chills and shortness of breath.
Bevacizumab precautions and contraindications
- Because these are two of the main side effects of bevacizumab treatment, continuous monitoring of both blood pressure and renal function during treatment is very important.
- Patients with a history of heart or kidney failure should take several precautions when using bevacizumab:
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- Cardiovascular monitoring: bevacizumab may worsen pre-existing heart problems, including congestive heart failure. It is crucial to report any sudden weight gain, swelling in the ankles or legs, chest pain or pressure, or excessive sweating to the doctor.
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- Blood pressure control: This medicine may cause high blood pressure. Patients should monitor their blood pressure regularly and report any significant increase to their doctor.
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- Kidney function: bevacizumab may affect kidney function, especially in patients with a history of kidney problems. It is important to have regular kidney function tests and to watch for symptoms such as decreased urine output or swelling in the limbs.
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- Wound healing: This medicine may affect wound healing. If surgery is needed, the medicine may need to be stopped before the procedure.
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- Side effects during infusion: Some patients may experience serious side effects during infusion of the medicine. It is essential to report any unusual symptoms to the doctor during this process.
Some medicines can interfere with bevacizumab treatment, and it is important that patients inform their doctor about all the medicines they are taking:
- Blood thinners: medicines that affect blood clotting, such as warfarin, may increase the risk of bleeding when used with bevacizumab.
- Blood pressure medicines: some antihypertensive medicines may need dose adjustments due to the effects of bevacizumab on blood pressure.
Tips for coping with bevacizumab treatment
People on bevacizumab treatment should follow a healthy, balanced diet to help manage side effects and maintain their strength and energy. Some general recommendations are:
- Hydration: it is essential to drink enough water, at least 2-2.5 litres a day, to maintain good hydration and help the kidneys eliminate toxins.
- Protein: Consuming sufficient protein is essential for tissue repair and maintenance of muscle mass. Include lean protein sources such as chicken, fish, eggs, legumes and low-fat dairy products.
- Fruits and vegetables: Include a variety of fruits and vegetables in your daily diet. These foods are rich in vitamins, minerals and antioxidants that can help strengthen the immune system.
- Fibre: to prevent constipation, which can be a side effect of treatment, eat fibre-rich foods such as whole grains, fruits, vegetables and legumes.
- Avoid processed foods: limit consumption of processed foods, refined sugars and saturated fats, as these can contribute to inflammation and other health problems.
- Small, frequent meals: try to eat small, frequent meals throughout the day rather than three large meals.
Exercise and emotional well-being
- To manage fatigue and improve emotional well-being during bevacizumab treatment, it is important to incorporate moderate physical activity and relaxation techniques into your daily routine. Here are some recommendations:
Moderate physical activity
- Daily walks: walking at a moderate pace for 30 minutes a day can improve mood and reduce fatigue.
- Yoga: yoga combines physical exercise with breathing techniques and meditation, which can help reduce stress and improve flexibility and strength.
- Low-impact exercise: activities such as swimming or cycling are excellent ways to stay active without overtaxing the body.
Relaxation techniques
- Meditation: practising meditation for 10-15 minutes a day can help calm the mind and reduce anxiety.
- Deep breathing: deep breathing techniques can be helpful to relax and reduce stress. It is recommended to inhale deeply through the nose, hold the breath for a few seconds and exhale slowly through the mouth.
- Mindfulness: Mindfulness practice, which involves being present and aware in the moment, can improve emotional well-being and help to better manage fatigue.
Additional Tips
- Adequate rest: it is important to get enough sleep each night to allow the body to recover.
- Balanced nutrition: maintain a balanced diet to provide the body with the nutrients it needs to combat fatigue.
- Social support: talking to friends, family or a therapist can be very beneficial for emotional well-being.
Importance of medical follow-up and open communication
Medical follow-up and open communication are essential during treatment with bevacizumab for several reasons:
Medical follow-up
- Monitoring for side effects: bevacizumab can cause side effects such as hypertension, scarring and bleeding problems, and kidney complications. Regular monitoring allows these effects to be detected and managed in a timely manner.
- Assessment of treatment efficacy: it is crucial to regularly evaluate the patient’s response to treatment in order to adjust doses or change the therapeutic strategy if necessary.
- Prevention of complications: monitoring helps prevent serious complications by identifying potential problems, such as infections or bleeding, early.
Open communication
- Transparency about symptoms: patients should report any new or unusual symptoms to their medical team. This includes changes in blood pressure, pain, swelling or any other discomfort.
- Discussion of concurrent medications: it is important for patients to report all medications they are taking, including over-the-counter and supplements, to avoid adverse interactions.
- Emotional support: open communication also allows patients to express their concerns and receive emotional support, which is vital to their overall well-being during treatment.
Bevacizumab is a monoclonal antibody that plays a crucial role in the treatment of several types of cancer by inhibiting angiogenesis, the process by which tumours develop new blood vessels to obtain nutrients and grow.
Bevacizumab binds to vascular endothelial growth factor (VEGF), a protein that stimulates the formation of new blood vessels. By blocking VEGF, bevacizumab prevents tumours from developing their own network of blood vessels, limiting their growth and spread.
It has also been shown to be effective in prolonging life and improving quality of life in patients with advanced cancer. Its ability to inhibit angiogenesis is key to its effectiveness, but it can cause significant side effects, such as hypertension, scarring problems and kidney complications. Close medical follow-up is crucial to manage these risks.
