Avastin400 mg/16 ml

Avastin 400 mg/16 ml is a vascular endothelial growth factor-specific angiogenesis inhibitor indicated for the treatment of: Metastatic colorectal cancer, with intravenous 5-fluorouracil-based chemotherapy for first-or second-line treatment. Metastatic colorectal cancer, with fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy for second-line treatment in patients who have progressed on a first-line Avastin 400 mg/16 ml containing regimen. ... Read moreAvastin 400 mg/16 ml is a vascular endothelial growth factor-specific angiogenesis inhibitor indicated for the treatment of: Metastatic colorectal cancer, with intravenous 5-fluorouracil-based chemotherapy for first-or second-line treatment. Metastatic colorectal cancer, with fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy for second-line treatment in patients who have progressed on a first-line Avastin 400 mg/16 ml containing regimen. Non-squamous non-small cell lung cancer, with carboplatin and paclitaxel for first-line treatment of unresectable, locally advanced, recurrent or metastatic disease. Glioblastoma, as a single agent for adult patients with progressive disease following prior therapy. Effectiveness of Avastin 400 mg/16 ml is based on improvement in objective response rate. No data available demonstrating improvement in disease-related symptoms or survival with Avastin 400 mg/16 ml. Metastatic renal cell carcinoma with interferon alfa. Cervical cancer, in combination with paclitaxel and cisplatin or paclitaxel and topotecan in persistent, recurrent, or metastatic disease. Recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer that is: (1) Platinum-resistant in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan. (2) Platinum-sensitive in combination with carboplatin and paclitaxel or in combination with carboplatin and gemcitabine, followed by Avastin 400 mg/16 ml as a single agent. Limitation of Use: Avastin 400 mg/16 ml is not indicated for adjuvant treatment of colon cancer.

Targeted Cancer Therapy

Avastin 400 mg/16 ml binds VEGF and prevents the interaction of VEGF to its receptors (Flt-1 and KDR) on the surface of endothelial cells. The interaction of VEGF with its receptors leads to endothelial cell proliferation and new blood vessel formation in in vitro models of angiogenesis. Administration of Avastin 400 mg/16 ml to xenotransplant models of colon cancer in nude (athymic) mice caused reduction of microvascular growth and inhibition of metastatic disease progression.

Patients should continue treatment until disease progression or unacceptable toxicity.Metastatic Colorectal Cancer (mCRC): The recommended doses are 5 mg/kg or 10 mg/kg every 2 weeks when used in combination with intravenous 5-FU-based chemotherapy. Administer 5 mg/kg when used in combination with bolus-IFL. Administer 10 mg/kg when used in combination with FOLFOX4. Administer 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks when used in combination with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line Avastin 400 mg/16 ml-containing regimen. Non-Squamous Non-Small Cell Lung Cancer: (NSNSCLC): The recommended dose is 15 mg/kg every 3 weeks in combination with carboplatin and paclitaxel.Glioblastoma: The recommended dose is 10 mg/kg every 2 weeks.Metastatic Renal Cell Carcinoma (mRCC): The recommended dose is 10 mg/kg every 2 weeks in combination with interferon alfa.Cervical Cancer: The recommended dose of Avastin 400 mg/16 ml is 15 mg/kg every 3 weeks as an intravenous infusion administered in combination with one of the following chemotherapy regimens: paclitaxel and cisplatin, or paclitaxel and topotecan.Platinum-Resistant Recurrent Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer: The recommended dose is 10mg/kg every 2 weeks in combination with one of the following intravenous chemotherapy regimens: paclitaxel, pegylated liposomal doxorubicin, or topotecan (weekly); or 15 mg/kg every 3 weeks in combination with topotecan (every 3 weeks).Platinum-Sensitive Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer: The recommended dose is 15 mg/kg every 3 weeks when administered in combination with carboplatin and paclitaxel for 6 cycles and up to 8 cycles, followed by continued use of Avastin 400 mg/16 ml 15 mg/kg every 3 weeks as a single agent until disease progression. Alternatively, 15 mg/kg every 3 weeks when administrated in combination with carboplatin and gemcitabine for 6 cycles and up to 10 cycles, followed by continued use of Avastin 400 mg/16 ml 15 mg/kg every 3 weeks as a single agent until disease progression.

Do not administer as an IV push or bolus. Do not initiate Avastin 400 mg/16 ml for 28 days following major surgery (until surgical wound is fully healed).First infusion: Administer infusion over 90 minutes. Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.Preparation for Administration: Use appropriate aseptic technique. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Withdraw the necessary amount of Avastin 400 mg/16 ml and dilute in a total volume of 100 ml of 0.9% Sodium Chloride injection, USP. Discard any unused portion left in a vial, as the product contains no preservatives.

A drug interaction study was performed in which irinotecan was administered as part of the FOLFIRIregimen with or without Avastin 400 mg/16 ml. The results demonstrated no significant effect of Avastin 400 mg/16 ml on the pharmacokinetics of irinotecan or its active metabolite SN38.

There are no contraindications listed in the manufacturer’s labeling.

Most common adverse reactions (incidence >10% and at least twice the control arm rate) are epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, back pain and exfoliative dermatitis.

Pregnancy Category C. There are no adequate or well controlled studies of Avastin 400 mg/16 ml in pregnant women.  It is not known whether Avastin is secreted in human milk.

Perforation or Fistula: Discontinue Avastin 400 mg/16 ml if perforation or fistula occurs.Arterial Thromboembolic Events or ATE (e.g., myocardial infarction, cerebral infarction): Discontinue Avastin 400 mg/16 ml for severe ATE.Venous Thromboembolic Events or VTE: Discontinue Avastin 400 mg/16 ml for lifethreatening VTE.Hypertension: Monitor blood pressure and treat hypertension. Temporarily suspend Avastin 400 mg/16 ml if not medically controlled. Discontinue Avastin 400 mg/16 ml for hypertensive crisis or hypertensive encephalopathy.Posterior Reversible Encephalopathy Syndrome (PRES): Discontinue Avastin 400 mg/16 ml.Proteinuria: Monitor urine protein. Discontinue Avastin 400 mg/16 ml for nephrotic syndrome. Temporarily suspend Avastin 400 mg/16 ml for moderate proteinuria.Infusion Reactions: Stop Avastin 400 mg/16 ml for severe infusion reactions.Embryo-fetal Toxicity: Advise females of potential risk to a fetus and the need for use of effective contraception.Ovarian Failure: Advise females of the potential risk.

The highest dose tested in humans (20 mg/kg IV) was associated with headache in nine out of 16 patients and with severe headache in three out of 16 patients.

Store the Avastin 400 mg/16 ml vial in a refrigerator at 2-8°C. Keep the vial in the outer carton due to light sensitivity. Do not freeze. Keep out of reach of children.

The safety, effectiveness and pharmacokinetic profile of Avastin 400 mg/16 ml in pediatric patients have not been established. In published literature reports, cases of non-mandibular osteonecrosis have been observed in patients under the age of 18 years who have received Avastin 400 mg/16 ml. Avastin 400 mg/16 ml is not approved for use in patients under the age of 18 years.Antitumor activity was not observed among eight children with relapsed glioblastoma treated with Avastin 400 mg/16 ml and irinotecan. There is insufficient information to determine the safety and efficacy of Avastin 400 mg/16 ml in children with glioblastoma.

Use appropriate aseptic technique. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Withdraw necessary amount of Avastin 400 mg/16 ml and dilute in a total volume of 100 ml of 0.9% Sodium Chloride Injection, USP. Discard any unused portion left in a vial, as the product contains no preservatives.

Targeted Cancer Therapy

Avastin 400 mg/16 ml is a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF) in-vitro and in-vivo assay systems. Avastin 400 mg/16 ml contains human framework regions and the complementarity-determining regions of a murine antibody that binds to VEGF. Avastin 400 mg/16 ml has an approximate molecular weight of 149 kD. Avastin 400 mg/16 ml is produced in a mammalian cell (Chinese Hamster Ovary) expression system in a nutrient medium containing the antibiotic gentamicin. Gentamicin is not detectable in the final product. Avastin 400 mg/16 ml is a clear to slightly opalescent, colorless to pale brown, sterile, pH 6.2 solution for intravenous infusion.

Pregnancy: Avastin 400 mg/16 ml may cause fetal harm based on findings from animal studies and the drug’s mechanism of action.Lactation: No data are available regarding the presence of Avastin 400 mg/16 ml in human milk, the effects on the breast fed infant, or the effects on milk production. Human IgG is present in human milk, but published data suggest that breast milk antibodies do not enter the neonatal and infant circulation in substantial amounts. Because of the potential for serious adverse reactions in breastfed infants from Avastin 400 mg/16 ml, advise a nursing woman that breastfeeding is not recommended during treatment with Avastin 400 mg/16 ml.

Pediatric Use: The safety, effectiveness and pharmacokinetic profile of Avastin 400 mg/16 ml in pediatric patients have not been established. In published literature reports, cases of non-mandibular osteonecrosis have been observed in patients under the age of 18 years who have received Avastin 400 mg/16 ml. Avastin 400 mg/16 ml is not approved for use in patients under the age of 18 years. Antitumor activity was not observed among eight children with relapsed glioblastoma treated with Avastin 400 mg/16 ml and irinotecan. There is insufficient information to determine the safety and efficacy of Avastin 400 mg/16 ml in children with glioblastoma. Animal Data Juvenile cynomolgus monkeys with open growth plates exhibited physeal dysplasia following 4 to 26 weeks exposure at 0.4 to 20 times the recommended human dose (based on mg/kg and exposure). The incidence and severity of physeal dysplasia were dose-related and were partially reversible upon cessation of treatment.Geriatric Use In Study: Severe adverse events that occurred at a higher incidence (≥2%) in patients aged ≥65 years as compared to younger patients were asthenia, sepsis, deep thrombophlebitis, hypertension, hypotension, myocardial infarction, congestive heart failure, diarrhea, constipation, anorexia, leukopenia, anemia, dehydration, hypokalemia, and hyponatremia. The effect of Avastin 400 mg/16 ml on overall survival was similar in elderly patients as compared to younger patients.