Article

Nursing Considerations of Bevacizumab Use in Multiple Tumor Types

Barbara Holmes Gobel

tumor, cancer nursing assessment, vascular endothelial growth factor receptor, targeted therapy
ONF 2007, 34(3), 693-701. DOI: 10.1188/07.ONF.693-701

Purpose/Objectives: To update information concerning the antiangiogenic agent bevacizumab, discuss side effects, and provide information on nursing management of the side effects.

Data Sources: Published articles, abstracts, and research data.

Data Synthesis: In clinical trials, the addition of bevacizumab to standard chemotherapy increased survival in patients with metastatic colorectal cancer and advanced non-small cell lung cancer and increased progression-free survival in patients with metastatic breast cancer. Bevacizumab also is being evaluated in combination with other targeted agents in various tumor types. Commonly reported side effects associated with bevacizumab include hypertension, proteinuria, and minor bleeding.

Conclusions: The value of bevacizumab in treating metastatic colorectal cancer has long been established. Clinical trial data have demonstrated the benefit of using bevacizumab in combination with standard chemotherapy in the treatment of non-small cell lung cancer and metastatic breast cancer. Because of bevacizumab's expanding role in cancer treatment, nurses need to know how to use it, be aware of possible side effects, and anticipate interventions.

Implications for Nursing: Nurses play an important role in the identification and management of adverse events associated with bevacizumab.

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    References

    Bendell, J.C., Fernando, N., Morse, M., Blobe, G., Yu, D., Sutton, L., et al. (2006). A phase II study of oxaliplatin (OX), capecitabine (CAP), and bevacizumab (BV) in the treatment of metastatic colorectal cancer [Abstract 3541]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 156S.
    Bergsland, E., & Dickler, M.N. (2004). Maximizing the potential of bevacizumab in cancer treatment. Oncologist, 9(Suppl. 1), 36-42.
    Berry, S., Cunningham, D., Michael, M., Di Bartolomeo, M., Rivera, F., Kretzschmar, F., et al. (2006b). Preliminary safety of bevacizumab with first-line FOLFOX, CAPOX, FOLFIRI, and capecitabine for mcolorectal cancer—first BEATrial [Abstract 3534]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 154S.
    Berry, S., Michael, M., Kretzschmar, A., Cunningham, D., DiBartolomeo, M., Rivera, B., et al. (2006a). Lack of effect of starting bevacizumab shortly after venous access device implantation on wound healing/bleeding complications: Preliminary results from first BEAT [Abstract 245]. Proceedings of the 2006 Gastrointestinal Cancers Symposium.
    Carroll, M.F., & Temte, J.L. (2000). Proteinuria in adults: A diagnostic approach. American Family Physician, 62, 1333-1340.
    Fernando, N.H., & Hurwitz, H.I. (2004). Targeted therapy of colorectal cancer: Clinical experience with bevacizumab. Oncologist, 9(Suppl. 1), 11-18.
    Ferrara, N. (2004). Vascular endothelial growth factor as a target for anticancer therapy. Oncologist, 9(Suppl. 1), 2-10.
    Ferrara, N., & Davis-Smyth, T. (1997). The biology of vascular endothelial growth factor. Endocrine Reviews, 18, 4-25.
    Ferrara, N., & Kerbel, R.S. (2005). Angiogenesis as a therapeutic target. Nature, 438, 967-974.
    Franson, P.J., & Lapka, D.V. (2005). Antivascular endothelial growth factor monoclonal antibody therapy: A promising paradigm in colorectal cancer. Clinical Journal of Oncology Nursing, 9, 55-60.
    Genentech, Inc. (2005). Avastin® (bevacizumab) for intravenous use [Package insert]. South San Francisco, CA: Author.
    Gerber, H.P., & Ferrara, N. (2005). Pharmacology and pharmacodynamics of bevacizumab as monotherapy or in combination with cytotoxic therapy in preclinical studies. Cancer Research, 65, 671-680.
    Giantonio, B., Catalano, G., Meropol, N.J., O'Dwyer, P.J., Mitchell, E.P., Alberts, S.R., et al. (2005). High-dose bevacizumab improves survival when combined with FOLFOX4 in previously treated advanced colorectal cancer: Results from the Eastern Cooperative Oncology Group (ECOG) study E3200 [Abstract 2]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 1S.
    Gobel, B.H. (2005). Chemotherapy-induced hypersensitivity reactions. Oncology Nursing Forum, 32, 1027-1035.
    Goldberg, R.M., Sargent, D.J., Morton, R.F., Fuchs, C.S., Ramanathan, R.K., Williamson, S.K., et al. (2004). A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. Journal of Clinical Oncology, 22, 23-30.
    Hambleton, J., Skillings, J., Kabbinavar, F., Bergsland, E., Holmgren, E., Holden, S.N., et al. (2005). Safety of low-dose aspirin (ASA) in a pooled analysis of three randomized, controlled (RCTs) trials of bevacizumab (BV) with chemotherapy (CT) in patients with metastatic colorectal cancer (mcolorectal cancer) [Abstract 3554]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 259S.
    Hedrick, E., Kozloff, M., Hainsworth, J., Badarinath, A., Cohn, A., Flynn, P., et al. (2006). Safety of bevacizumab plus chemotherapy as first-line treatment of patients with metastatic colorectal cancer: Updated results from a large observational registry in the United States (BRiTE) [Abstract 3536]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 155S.
    Hochster, H.S., Hart, L., Ramanathan, R.K., Hainsworth, J.D., Griffing, S., Mass, R.D., et al. (2006). Safety and efficacy of oxaliplatin/fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer (mcolorectal cancer): Final analysis of the TREE-Study [Abstract 3510]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 148S.
    Holden, S., Ryan, E., Kearns, A., Holmgren, E., & Hurwitz, H. (2005). Benefit from bevacizumab (BV) is independent of pretreatment plasma vascular endothelial growth factor-A (pl-VEGF) in patients (pts) with metastatic colorectal cancer (mcolorectal cancer) [Abstract 3555]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 259s.
    Hu, L., Hofmann, J., Zaloudek, C., Ferrara, N., Hamilton, T., & Jaffe, R.B. (2002). Vascular endothelial growth factor immunoneutralization plus paclitaxel markedly reduces tumor burden and ascites in athymic mouse model of ovarian cancer. American Journal of Pathology, 161, 1917-1924.
    Hurwitz, H., Fehrenbacher, L., Novotny, W., Cartwright, T., Hainsworth, J., Heim, W., et al. (2004). Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. New England Journal of Medicine, 350, 2335-2342.
    Hurwitz, H.I., Fehrenbacher, L., Hainsworth, J.D., Heim, W., Berlin, J., Holmgren, E., et al. (2005). Bevacizumab in combination with fluorouracil and leucovorin: An active regimen for first-line metastatic colorectal cancer. Journal of Clinical Oncology, 23, 3502-3508.
    Jain, R.K. (2005). Normalization of tumor vasculature: An emerging concept in antiangiogenic therapy. Science, 307, 58-62.
    Johnson, D.H., Fehrenbacher, L., Novotny, W.F., Herbst, R.S., Nemunaitis, J.J., Jablons, D.M., et al. (2004). Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small cell lung cancer. Journal of Clinical Oncology, 22, 2184-2191.
    Kabbinavar, F., Hurwitz, H.I., Fehrenbacher, L., Meropol, N.J., Novotny, W.F., Lieberman, G., et al. (2003). Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. Journal of Clinical Oncology, 21, 60-65.
    Kabbinavar, F.F., Schulz, J., McCleod, M., Patel, T., Hamm, J.T., Hecht, J.R., et al. (2005). Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer: Results of a randomized phase II trial. Journal of Clinical Oncology, 23, 3697-3705.
    Kopetz, S., Abbruzzese, J.L., Eng, C., Adinin, R.B., Morris, J., Wolff, R.A., et al. (2006). Preliminary results from a phase II study of infusional 5-FU, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for metastatic colorectal cancer (mcolorectal cancer) [Abstract 3579]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 165S.
    Kozloff, M., Hainsworth, J., Badarinath, S., Cohn, A., Flynn, P., Steis, R., et al. (2006). Efficacy of bevacizumab plus chemotherapy as first-line treatment of patients with metastatic colorectal cancer: Updated results from a large observational registry in the US (BRiTE) [Abstract 3537]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. 1), 155s.
    Kretzschmar, A., Cunningham, D., Berry, S., DiBartolomeo, M., Michael, M., Rivera, F., et al. (2006). Incidence of gastrointestinal perforations and bleeding in patients starting bevacizumab treatment in first-line (mcolorectal cancer) without primary tumor resection: Preliminary results from the first BEATrial [Abstract 248]. Proceedings of the 2006 Gastrointestinal Cancers Symposium.
    Mass, R., Sarkar, S., Holden, S., & Hurwitz, H. (2005). Clinical benefit from bevacizumab (BV) in responding (R) and non-responding (NR) patients with metastatic colorectal cancer (mcolorectal cancer) [Abstract 3514]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. 1), 249S.
    Miller, K.D., Chap, L.I., Holmes, F.A., Cobleigh, M.A., Marcom, P.K., Fehrenbacher, L., et al. (2005a). Randomized phase III trial of capecitabine compared with bevacizumab plus capecitabine in patients with previously treated metastatic breast cancer. Journal of Clinical Oncology, 23, 792-799.
    Miller, K.D., Wang, M., Gralow, J., Dickler, M., Cobleigh, M.A., Perez, E.A., et al. (2005b). A randomized phase III trial of paclitaxel versus paclitaxel plus bevacizumab as first-line therapy for locally recurrent or metastatic breast cancer: A trial coordinated by the Eastern Cooperative Oncology Group (E2100). Breast Cancer Research and Treatment, 94(Suppl. 1), S6.
    Novotny, W.F., Holmgren, E., Nelson, B., Mass, R., Kabbinavar, F., & Hurwitz, H. (2004). Bevacizumab (a monoclonal antibody to vascular endothelial growth factor) does not increase the incidence of venous thromboembolism when added to first-line chemotherapy to treat metastatic colorectal cancer [Abstract 3529]. Journal of Clinical Oncology, 22(Suppl. 14), 252.
    Ralston, S.H., Caine, N., Richards, I., O'Reilly, D., Sturrock, R.D., & Capell, H.A. (1988). Screening for proteinuria in a rheumatology clinic: Comparison of dipstick testing, 24 hour urine quantitative protein, and protein/creatinine ratio in random urine samples. Annals of the Rheumatic Diseases, 47, 759-763.
    Reiger, P. (2001). Patient management: Assessment during therapy. In P. Reiger (Ed.), Biotherapy: A comprehensive overview. (2nd ed., p. 465). Sudbury, MA: Jones and Bartlett.
    Rodby, R.A., Rohde, R.D., Sharon, Z., Pohl, M.A., Bain, R.P., Lewis, E.J., et al. (1995). The urine protein to creatinine ratio as a predictor of 24-hour urine protein excretion in type 1 diabetic patients with nephropathy. The Collaborative Study Group. American Journal of Kidney Diseases, 26, 904-909.
    Rosiak, J., & Sadowski, L. (2005). Hypertension associated with bevacizumab. Clinical Journal of Oncology Nursing, 9, 407-411.
    Saltz, L.B., Chung, K.Y., Timoney, J., Park, V., & Hollywood, E. (2006). Simplification of bevacizumab (bev) administration: Do we need 90, 60, or even 30 minute infusion times? [Abstract 3542]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 256S.
    Saltz, L.B., Lenz, H.J., Hochster, H., Wadler, S., Hoff, P., Kemeny, N., et al. (2005). Randomized phase II trial of cetuximab/bevacizumab/irinotecan (CBI) versus cetuximab/bevacizumab (CB) in irinotecan-refractory colorectal cancer [Abstract 3508]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 248S.
    Sandler, A., Gray, R., Brahmer, J., Dowlati, A., Schiller, J.H., Perry, M.C., et al. (2005). Randomized phase II/III trial of paclitaxel (P) plus carboplatin (C) with or without bevacizumab (NSC #704865) in patients with advanced non-squamous non-small cell lung cancer (NSCLC): An Eastern Cooperative Oncology Group (ECOG) Trial - E4599 [Abstract 4]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 2S.
    Saudan, P.J., Brown, M.A., Farrell, T., & Shaw, L. (1997). Improved methods of assessing proteinuria in hypertensive pregnancy. British Journal of Obstetrics and Gynaecology, 104, 1159-1164.
    Scappaticci, F.A., Fehrenbacher, L., Cartwright, T., Hainsworth, J.D., Heim, W., Berlin, J., et al. (2005). Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. Journal of Surgical Oncology, 91, 173-180.
    Skillings, J., Johnson, D., Miller, K., Kabbinavar, F., Bergsland, E., Holmgren, E., et al. (2005). Arterial thromboembolic events (ATEs) in a pooled analysis of five randomized, controlled trials (RCTs) of bevacizumab (BV) with chemotherapy [Abstract 3019]. Journal of Clinical Oncology, 23(Suppl. 16, Pt. I), 16S.
    Sugrue, M., Kozloff, M., Hainsworth, J., Badarinath, S., Cohn, A., Flynn, P., et al. (2006). Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy [Abstract 3535]. Journal of Clinical Oncology, 24(Suppl. 18, Pt. I), 154S.
    Sweeney, C.J., Miller, K.D., Sissons, S.E., Nozaki, S., Heilman, D.K., Shen, J., et al. (2001). The antiangiogenic property of docetaxel is synergistic with a recombinant humanized monoclonal antibody against vascular endothelial growth factor or 2-methoxyestradiol but antagonized by endothelial growth factors. Cancer Research, 61, 3369-3372.
    Wildiers, H., Guetens, G., De Boeck, G., Verbeken, E., Landuyt, B., Landuyt, W., et al. (2003). Effect of antivascular endothelial growth factor treatment on the intratumoral uptake of CPT-11. British Journal of Cancer, 88, 1979-1986.
    Wilkes, G.M. (2005). Therapeutic options in the management of colon cancer: 2005 update. Clinical Journal of Oncology Nursing, 9, 31-44.
    Willett, C.G., Boucher, Y., di Tomaso, E., Duda, D.G., Munn, L.L., Tong, R.T., et al. (2004). Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nature Medicine, 10, 145-147.
    Yang, J.C., Haworth, L., Sherry, R.M., Hwu, P., Schwartzentruber, D.J., Topalian, S.L., et al. (2003). A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. New England Journal of Medicine, 349, 427-434.
    Yuan, F., Chen, Y., Dellian, M., Safabakhsh, N., Ferrara, N., & Jain, R.K. (1996). Time-dependent vascular regression and permeability changes in established human tumor xenografts induced by an anti-vascular endothelial growth factor/vascular permeability factor antibody. Proceedings of the National Academy of Sciences of the United States of America, 93, 14765-14770.