Drugs List

Therapeutic Indications

Uses

Advanced (FIGO stage IIIB, IIIC & IV) epithelial ovarian cancer
Advanced and/or metastatic renal cell cancer
Advanced, metastatic or recurrent non-small cell lung cancer
Advanced/metastatic non-small cell lung cancer with EGFR-TK mutations
Fallopian tube cancer
Metastatic breast cancer
Metastatic colorectal cancer
Primary peritoneal cancer
Recurrent, persistent or metastatic cervical cancer

Treatment of metastatic colorectal carcinoma, in combination with fluoropyrimidine-based treatment.

First line treatment of metastatic breast cancer in combination with paclitaxel.

First line treatment of metastatic breast cancer in combination with capecitabine where chemotherapy options including taxanes or anthracyclines is not considered appropriate. Patients who have received taxane and anthracycline-containing regimens in the adjuvant setting within the last 12 months should be excluded from treatment with bevacizumab in combination with capecitabine.

First line treatment in combination with platinum-based chemotherapy of unresectable advanced, metastatic or recurrent non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology.

First line treatment in combination with erlotinib of unresectable advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) activating mutations.

First line treatment in combination with interferon alfa-2a of advanced and/or metastatic renal cell cancer.

Front-line treatment of advanced (FIGO stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and paclitaxel.

Treatment of first recurrence of platinum-sensitive epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and gemcitabine or in combination with carboplatin and paclitaxel. In patients who have received no prior treatment with VEGF inhibitors or VEGF receptor targeted agents.

Treatment of recurrent platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with paclitaxel, topotecan or pegylated liposomal doxorubicin. In patients who have received no more than two prior chemotherapy regimens and with no prior treatment with VEGF inhibitors or VEGF receptor targeted agents.

Treatment of persistent, recurrent or metastatic cervical cancer in combination with paclitaxel and cisplatin or paclitaxel and topotecan, in patients unable to receive platinum therapy.

Administration

Intravenous infusion after dilution only.

For all indications, the initial dose should be delivered over 90 minutes as an intravenous infusion. If the initial dose is well tolerated, the next dose may be administered over 60 minutes. If this dose is well tolerated, subsequent doses may be administered over 30 minutes.

Contraindications

Children under 18 years
Haemoptysis
Within 4 weeks of surgery
Breastfeeding
Pregnancy
Recent pulmonary haemorrhage

Precautions and Warnings

Females of childbearing potential
Haemorrhagic diathesis
History of radiotherapy
History of treatment with anthracyclines
Intra-abdominal inflammation
Patients over 65 years
Tobacco smoking
Behcet's disease
Cardiovascular disorder
Central nervous system metastasis
Cerebrovascular disorder
Coagulopathy
Congestive cardiac failure
Diabetes mellitus
Giant cell arteritis
Hepatic impairment
History of aneurysm
History of thromboembolic disorder
Hyperlipidaemia
Hypertension
Ischaemic heart disease
Marfan syndrome
Occlusive peripheral arterial disease
Renal impairment
Takayasu arteritis
Vascular Ehlers-Danlos syndrome

Advise ability to drive/operate machinery may be affected by side effects
Confirm EGFR mutation status of tumour prior to treatment
Consider a dental exam & appropriate preventive dentistry before treatment
Ensure hypertension is controlled prior to treatment
Give pre-treatment counselling and consideration of oocyte cryopreservation
Consult local policy on the safe use of anti-cancer drugs
Dilute and use as an infusion
Do not start therapy for 28 days post surgery, or until wound has healed
Record name and batch number of administered product
Staff: Not to be handled by pregnant staff
Treatment to be administered under the supervision of a specialist
Monitor for proteinuria before and periodically during treatment
Monitor blood pressure regularly
Monitor for haemorrhage especially intracranial bleeds
Monitor patient for infusion-associated reactions (IARs)
Monitor patients at risk for signs & symptoms of thromboembolism
Advise patient to report headaches, seizures, confusion, visual disturbance
Advise patient to report unexplained fever, sore throat, bruising, bleeding
Discontinue if Grade 3 or 4 bleeding occurs
Elderly patients may be more susceptible to local and systemic effects
May increase the risk of tumour associated haemorrhage
Non small cell lung cancer: risk of pulmonary haemorrhage
Treatment may adversely affect wound healing
Discontinue if arterial thromboembolism develops
Discontinue if fistulae develop during treatment
Discontinue if Grade 4 proteinuria occurs (Nephrotic syndrome)
Discontinue if grade 4 thromboembolic event occurs
Discontinue if hypersensitivity reactions occur
Discontinue if hypertensive encephalopathy occurs
Discontinue if necrotising fasciitis occurs
Discontinue if persistent hypertension unresponsive to therapy occurs
Discontinue if posterior reversible encephalopathy syndrome (PRES) develops
Discontinue if pulmonary embolism occurs
Discontinue permanently if any grade 4 fistula occurs
Discontinue permanently if hypertensive crisis occurs
Discontinue prior to surgery
Discontinue treatment if gastrointestinal perforation occurs
Female: May cause infertility
Female: Contraception required during and for 6 months after treatment
Breastfeeding: Do not breastfeed during & for 6 months after treatment
Advise patient on giving up smoking

Gastrointestinal perforations
Caution should be used when treating patients for metastatic carcinoma of the colon or rectum with an intra-abdominal inflammatory condition as there may be an increased risk of developing gastrointestinal and gall bladder perforation during treatment.

Prior radiation is a risk factor for GI perforation in patients treated for cervical cancer.

Fistulae
Treatment should be permanently discontinued in patients with any tracheoesophageal fistula or any grade 4 fistula.

Consider discontinuing treatment in patients with internal fistula not arising from gastrointestinal tract.

Patients being treated for cervical cancer with a history of prior radiation are at an increased risk of developing GI-vaginal fistulae.

Wound healing complications
In patients who have experienced wound healing complications, therapy should be withheld until the wound is fully healed.

Therapy should be withheld for elective surgery.

Hypertension
An increased incidence of hypertension, thought likely to be dose related, was observed in patients treated with bevacizumab.

The use of diuretics is not advised if the patient is receiving a cisplatin-based chemotherapy regimen.

Patients with a history of hypertension may be at an increased risk for the development of proteinuria.

Thromboembolism
In randomised clinical trials, the incidence of arterial thromboembolic events, was higher in patients receiving bevacizumab in combination with chemotherapy compared to chemotherapy alone.

Use with caution in patients with a history of arterial thromboembolic events, diabetes mellitus or aged 65 years or over as there may be an increased risk of developing arterial thromboembolic events during treatment.

Discontinue bevacizumab in patients with grade 4 (life-threatening) pulmonary embolism and monitor patients with grade 3 or lower closely.

Congestive heart failure
Caution should be used when treating patients who have previously had anthracycline exposure or radiotherapy to the chest wall, as there may be an increased risk of developing congestive heart failure.

Neutropenia
Increased rates of severe neutropenia, febrile neutropenia, or infection (including some fatalities) have been observed when bevacizumab is added to myelotoxic chemotherapy regimes.

Osteonecrosis of the jaw
A dental examination and appropriate preventative dentistry should be considered prior to starting treatment with bevacizumab. Patients who have previously received or are currently receiving intravenous bisphosphonates should avoid invasive dental procedures if possible.

Posterior Reversible Encephalopathy Syndrome (PRES)
Posterior reversible encephalopathy syndrome (PRES) has been reported in some patients treated with bevacizumab If patients present with symptoms indicating PRES such as headache, altered mental state, seizures and visual disturbances, an MRI should be performed. If PRES is diagnosed bevacizumab treatment should be discontinued and adequate blood pressure and seizure control administration is advisable.The safety of reinstating treatment in patients previously experiencing PRES is unknown.

Risk factors for aneurysm and artery dissection
Use of systemic VEGF inhibitors may promote the formation of aneurysms or artery dissections, mainly in relation to aortic aneurysm rupture and aortic dissection. It is therefore important to consider the risk of aneurysm and artery dissection in patients with risk factors such as hypertension, history of aneurysm, smoking, diabetes, coronary, cerebrovascular or peripheral arterial disease, and hyperlipidaemia. Other risk factors include Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu arteritis, and the use of fluoroquinolones. In patients receiving VEGF inhibitors, any modifiable risk factors such as smoking and hypertension should be reduced as far as possible.

Other
Bevacizumab is not licensed for use in combination with sunitinib for any indication. There have been reports of microangiopathic haemolytic anaemia in clinical trials where this combination was used for treatment of metastatic renal cell carcinoma.

Pregnancy and Lactation

Pregnancy

Bevacizumab is contraindicated during pregnancy.

The manufacturer recommends that bevacizumab is contraindicated during pregnancy.

There are no data on the safety of bevacizumab in pregnant women, however animal studies have shown reproductive toxicity, including malformations. Bevacizumab is anticipated to inhibit angiogenesis in the foetus and this causes serious birth defects. It is not known if bevacizumab crosses the human placenta. Although it is a large molecule, some immune globulins including IgG are transported across the placenta to the embryo and/or foetus. The effect of concurrent therapies must also be considered.

Lactation

Bevacizumab is contraindicated during breastfeeding.

The manufacturer recommends that women must discontinue breastfeeding during bevacizumab treatment and for at least 6 months after the last dose. It is not known whether bevacizumab is excreted in human breast milk, although immunoglobulins do pass into milk. The effect of concurrent therapies must also be considered.

Side Effects

Abdominal pain
Abscess
Anaemia
Anaphylactoid reaction
Anaphylaxis
Aneurysm
Anorexia
Arterial thrombosis
Artery dissection
Arthralgia
Asthenia
Back pain
Cellulitis
Cerebrovascular accident
Congestive cardiac failure
Constipation
Cough
Decrease in haemoglobin
Deep vein thrombosis (DVT)
Dehydration
Diarrhoea
Dry skin
Dysarthria
Dysgeusia
Dysphonia
Dyspnoea
Epistaxis
Exfoliative dermatitis
Eye disorder
Fatigue
Febrile neutropenia
Fistulae
Foetal defects
Gall bladder rupture
Gastro-intestinal perforation
Gastro-intestinal ulceration
Gastrointestinal disorder
Haemoptysis
Haemorrhage
Headache
Hyperglycaemia
Hypersensitivity reactions
Hypertension
Hypertensive crisis
Hypertensive encephalopathy
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypoxia
Ileus
Impaired fertility
Increased lacrimation
Infections
Intestinal obstruction
Lethargy
Leukopenia
Lymphopenia
Melaena
Mucosal inflammation
Muscle weakness
Myalgia
Myocardial infarction
Nausea
Necrotising fasciitis
Nephrotic syndrome
Neutropenia
Osteonecrosis (primarily of the jaw)
Ovarian failure
Pain
Palmar-Plantar Erythrodysaesthesia syndrome
Pelvic pain
Perforation of nasal septum
Peripheral neuropathy
Posterior reversible encephalopathy syndrome (PRES)
Proctalgia
Proteinuria
Pulmonary embolism
Pulmonary haemorrhage
Pulmonary hypertension
Pyrexia
Rectal haemorrhage
Rectovaginal fistula
Reversible posterior leucoencephalopathy syndrome (RPLS)
Rhinitis
Sepsis
Skin discolouration
Somnolence
Stomatitis
Supraventricular tachycardia
Syncope
Thrombocytopenia
Thromboembolism
Thrombophlebitis
Thrombotic microangiopathy
Transient ischaemic attack
Tumour haemorrhage
Urinary tract infections
Vomiting
Weight loss
Wound healing retarded

Presentation

Concentrate for solution for infusion containing bevacizumab.

Drugs List

Therapeutic Indications

Uses

Advanced (FIGO stage IIIB, IIIC & IV) epithelial ovarian cancer
Advanced and/or metastatic renal cell cancer
Advanced, metastatic or recurrent non-small cell lung cancer
Advanced/metastatic non-small cell lung cancer with EGFR-TK mutations
Fallopian tube cancer
Metastatic breast cancer
Metastatic colorectal cancer
Primary peritoneal cancer
Recurrent, persistent or metastatic cervical cancer

Treatment of metastatic colorectal carcinoma, in combination with fluoropyrimidine-based treatment.

First line treatment of metastatic breast cancer in combination with paclitaxel.

First line treatment of metastatic breast cancer in combination with capecitabine where chemotherapy options including taxanes or anthracyclines is not considered appropriate. Patients who have received taxane and anthracycline-containing regimens in the adjuvant setting within the last 12 months should be excluded from treatment with bevacizumab in combination with capecitabine.

First line treatment in combination with platinum-based chemotherapy of unresectable advanced, metastatic or recurrent non-small cell lung cancer (NSCLC) other than predominantly squamous cell histology.

First line treatment in combination with erlotinib of unresectable advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) activating mutations.

First line treatment in combination with interferon alfa-2a of advanced and/or metastatic renal cell cancer.

Front-line treatment of advanced (FIGO stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and paclitaxel.

Treatment of first recurrence of platinum-sensitive epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and gemcitabine or in combination with carboplatin and paclitaxel. In patients who have received no prior treatment with VEGF inhibitors or VEGF receptor targeted agents.

Treatment of recurrent platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with paclitaxel, topotecan or pegylated liposomal doxorubicin. In patients who have received no more than two prior chemotherapy regimens and with no prior treatment with VEGF inhibitors or VEGF receptor targeted agents.

Treatment of persistent, recurrent or metastatic cervical cancer in combination with paclitaxel and cisplatin or paclitaxel and topotecan, in patients unable to receive platinum therapy.

Dosage

Whilst the doses stated below are those recommended by the manufacturer, local cancer network protocols for the relevant indication should be consulted.

Patients should continue treatment until disease progression or unacceptable toxicity.

Adults

Administration

Intravenous infusion after dilution only.

For all indications, the initial dose should be delivered over 90 minutes as an intravenous infusion. If the initial dose is well tolerated, the next dose may be administered over 60 minutes. If this dose is well tolerated, subsequent doses may be administered over 30 minutes.

Contraindications

Children under 18 years
Haemoptysis
Within 4 weeks of surgery
Breastfeeding
Pregnancy
Recent pulmonary haemorrhage

Precautions and Warnings

Females of childbearing potential
Haemorrhagic diathesis
History of radiotherapy
History of treatment with anthracyclines
Intra-abdominal inflammation
Patients over 65 years
Tobacco smoking
Behcet's disease
Cardiovascular disorder
Central nervous system metastasis
Cerebrovascular disorder
Coagulopathy
Congestive cardiac failure
Diabetes mellitus
Giant cell arteritis
Hepatic impairment
History of aneurysm
History of thromboembolic disorder
Hyperlipidaemia
Hypertension
Ischaemic heart disease
Marfan syndrome
Occlusive peripheral arterial disease
Renal impairment
Takayasu arteritis
Vascular Ehlers-Danlos syndrome

Advise ability to drive/operate machinery may be affected by side effects
Confirm EGFR mutation status of tumour prior to treatment
Consider a dental exam & appropriate preventive dentistry before treatment
Ensure hypertension is controlled prior to treatment
Give pre-treatment counselling and consideration of oocyte cryopreservation
Consult local policy on the safe use of anti-cancer drugs
Dilute and use as an infusion
Do not start therapy for 28 days post surgery, or until wound has healed
Record name and batch number of administered product
Staff: Not to be handled by pregnant staff
Treatment to be administered under the supervision of a specialist
Monitor for proteinuria before and periodically during treatment
Monitor blood pressure regularly
Monitor for haemorrhage especially intracranial bleeds
Monitor patient for infusion-associated reactions (IARs)
Monitor patients at risk for signs & symptoms of thromboembolism
Advise patient to report headaches, seizures, confusion, visual disturbance
Advise patient to report unexplained fever, sore throat, bruising, bleeding
Discontinue if Grade 3 or 4 bleeding occurs
Elderly patients may be more susceptible to local and systemic effects
May increase the risk of tumour associated haemorrhage
Non small cell lung cancer: risk of pulmonary haemorrhage
Treatment may adversely affect wound healing
Discontinue if arterial thromboembolism develops
Discontinue if fistulae develop during treatment
Discontinue if Grade 4 proteinuria occurs (Nephrotic syndrome)
Discontinue if grade 4 thromboembolic event occurs
Discontinue if hypersensitivity reactions occur
Discontinue if hypertensive encephalopathy occurs
Discontinue if necrotising fasciitis occurs
Discontinue if persistent hypertension unresponsive to therapy occurs
Discontinue if posterior reversible encephalopathy syndrome (PRES) develops
Discontinue if pulmonary embolism occurs
Discontinue permanently if any grade 4 fistula occurs
Discontinue permanently if hypertensive crisis occurs
Discontinue prior to surgery
Discontinue treatment if gastrointestinal perforation occurs
Female: May cause infertility
Female: Contraception required during and for 6 months after treatment
Breastfeeding: Do not breastfeed during & for 6 months after treatment
Advise patient on giving up smoking

Gastrointestinal perforations
Caution should be used when treating patients for metastatic carcinoma of the colon or rectum with an intra-abdominal inflammatory condition as there may be an increased risk of developing gastrointestinal and gall bladder perforation during treatment.

Prior radiation is a risk factor for GI perforation in patients treated for cervical cancer.

Fistulae
Treatment should be permanently discontinued in patients with any tracheoesophageal fistula or any grade 4 fistula.

Consider discontinuing treatment in patients with internal fistula not arising from gastrointestinal tract.

Patients being treated for cervical cancer with a history of prior radiation are at an increased risk of developing GI-vaginal fistulae.

Wound healing complications
In patients who have experienced wound healing complications, therapy should be withheld until the wound is fully healed.

Therapy should be withheld for elective surgery.

Hypertension
An increased incidence of hypertension, thought likely to be dose related, was observed in patients treated with bevacizumab.

The use of diuretics is not advised if the patient is receiving a cisplatin-based chemotherapy regimen.

Patients with a history of hypertension may be at an increased risk for the development of proteinuria.

Thromboembolism
In randomised clinical trials, the incidence of arterial thromboembolic events, was higher in patients receiving bevacizumab in combination with chemotherapy compared to chemotherapy alone.

Use with caution in patients with a history of arterial thromboembolic events, diabetes mellitus or aged 65 years or over as there may be an increased risk of developing arterial thromboembolic events during treatment.

Discontinue bevacizumab in patients with grade 4 (life-threatening) pulmonary embolism and monitor patients with grade 3 or lower closely.

Congestive heart failure
Caution should be used when treating patients who have previously had anthracycline exposure or radiotherapy to the chest wall, as there may be an increased risk of developing congestive heart failure.

Neutropenia
Increased rates of severe neutropenia, febrile neutropenia, or infection (including some fatalities) have been observed when bevacizumab is added to myelotoxic chemotherapy regimes.

Osteonecrosis of the jaw
A dental examination and appropriate preventative dentistry should be considered prior to starting treatment with bevacizumab. Patients who have previously received or are currently receiving intravenous bisphosphonates should avoid invasive dental procedures if possible.

Posterior Reversible Encephalopathy Syndrome (PRES)
Posterior reversible encephalopathy syndrome (PRES) has been reported in some patients treated with bevacizumab If patients present with symptoms indicating PRES such as headache, altered mental state, seizures and visual disturbances, an MRI should be performed. If PRES is diagnosed bevacizumab treatment should be discontinued and adequate blood pressure and seizure control administration is advisable.The safety of reinstating treatment in patients previously experiencing PRES is unknown.

Risk factors for aneurysm and artery dissection
Use of systemic VEGF inhibitors may promote the formation of aneurysms or artery dissections, mainly in relation to aortic aneurysm rupture and aortic dissection. It is therefore important to consider the risk of aneurysm and artery dissection in patients with risk factors such as hypertension, history of aneurysm, smoking, diabetes, coronary, cerebrovascular or peripheral arterial disease, and hyperlipidaemia. Other risk factors include Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu arteritis, and the use of fluoroquinolones. In patients receiving VEGF inhibitors, any modifiable risk factors such as smoking and hypertension should be reduced as far as possible.

Other
Bevacizumab is not licensed for use in combination with sunitinib for any indication. There have been reports of microangiopathic haemolytic anaemia in clinical trials where this combination was used for treatment of metastatic renal cell carcinoma.

Pregnancy and Lactation

Pregnancy

Bevacizumab is contraindicated during pregnancy.

The manufacturer recommends that bevacizumab is contraindicated during pregnancy.

There are no data on the safety of bevacizumab in pregnant women, however animal studies have shown reproductive toxicity, including malformations. Bevacizumab is anticipated to inhibit angiogenesis in the foetus and this causes serious birth defects. It is not known if bevacizumab crosses the human placenta. Although it is a large molecule, some immune globulins including IgG are transported across the placenta to the embryo and/or foetus. The effect of concurrent therapies must also be considered.

Lactation

Bevacizumab is contraindicated during breastfeeding.

The manufacturer recommends that women must discontinue breastfeeding during bevacizumab treatment and for at least 6 months after the last dose. It is not known whether bevacizumab is excreted in human breast milk, although immunoglobulins do pass into milk. The effect of concurrent therapies must also be considered.

Side Effects

Abdominal pain
Abscess
Anaemia
Anaphylactoid reaction
Anaphylaxis
Aneurysm
Anorexia
Arterial thrombosis
Artery dissection
Arthralgia
Asthenia
Back pain
Cellulitis
Cerebrovascular accident
Congestive cardiac failure
Constipation
Cough
Decrease in haemoglobin
Deep vein thrombosis (DVT)
Dehydration
Diarrhoea
Dry skin
Dysarthria
Dysgeusia
Dysphonia
Dyspnoea
Epistaxis
Exfoliative dermatitis
Eye disorder
Fatigue
Febrile neutropenia
Fistulae
Foetal defects
Gall bladder rupture
Gastro-intestinal perforation
Gastro-intestinal ulceration
Gastrointestinal disorder
Haemoptysis
Haemorrhage
Headache
Hyperglycaemia
Hypersensitivity reactions
Hypertension
Hypertensive crisis
Hypertensive encephalopathy
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Hypoxia
Ileus
Impaired fertility
Increased lacrimation
Infections
Intestinal obstruction
Lethargy
Leukopenia
Lymphopenia
Melaena
Mucosal inflammation
Muscle weakness
Myalgia
Myocardial infarction
Nausea
Necrotising fasciitis
Nephrotic syndrome
Neutropenia
Osteonecrosis (primarily of the jaw)
Ovarian failure
Pain
Palmar-Plantar Erythrodysaesthesia syndrome
Pelvic pain
Perforation of nasal septum
Peripheral neuropathy
Posterior reversible encephalopathy syndrome (PRES)
Proctalgia
Proteinuria
Pulmonary embolism
Pulmonary haemorrhage
Pulmonary hypertension
Pyrexia
Rectal haemorrhage
Rectovaginal fistula
Reversible posterior leucoencephalopathy syndrome (RPLS)
Rhinitis
Sepsis
Skin discolouration
Somnolence
Stomatitis
Supraventricular tachycardia
Syncope
Thrombocytopenia
Thromboembolism
Thrombophlebitis
Thrombotic microangiopathy
Transient ischaemic attack
Tumour haemorrhage
Urinary tract infections
Vomiting
Weight loss
Wound healing retarded

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2020

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Alymsys 25mg/ml concentrate for solution for infusion. Zentiva. Revised April 2021.

Summary of Product Characteristics: Avastin 25mg/ml concentrate for solution for infusion. Roche Products Ltd. Revised January 2021.

Summary of Product Characteristics: Aybintio 25mg/ml concentrate for solution for infusion. Merck Sharp & Dohme Limited. Revised May 2021.

Summary of Product Characteristics: Oyavas 25mg/ml concentrate for solution for infusion. Thornton and Ross Ltd. Revised July 2021.

Summary of Product Characteristics: Vegzelma 25mg/ml concentrate for solution for infusion. Celltrion Healthcare UK Ltd. Revised September 2022.

Summary of Product Characteristics: Zirabev 25mg/ml concentrate for solution for infusion. Pfizer Limited. Revised May 2021.

MHRA Drug Safety Update July 2020
Available at: https://www.gov.uk/drug-safety-update/systemically-administered-vegf-pathway-inhibitors-risk-of-aneurysm-and-artery-dissection
Last accessed: 23 June 2021

NICE Evidence Services
Available at: www.nice.org.uk
Last accessed: 23 June 2021

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Bevacizumab Last revised: April 19, 2021
Last accessed: June 23, 2021