Bevacizumab Patients Require Close Monitoring of Risks

• BOSTON—The monoclonal antibody bevacizumab (Avastin) is likely to have a variety of uses in cancer treatment but also carries with it risks that require careful monitoring by oncology nursing staff, Caroline Clark, RN, of Memorial Sloan-Kettering Cancer Center, said at the Oncology Nursing Society 31st Annual Congress (abstract 43). Jeanine Gordon, BSN, OCN, was coauthor.

Bevacizumab is approved for the first-line treatment of unresectable, locally advanced, recurrent or metastatic nonsquamous, non-small-cell lung cancer (NSCLC), and for first- or second-line treatment of metastatic colorectal carcinoma. For NSCLC, bevacizumab is given in combination with carboplatin and paclitaxel. For metastatic colorectal cancer, it is given in combination with intravenous 5-fluorouracil-based regimens.

Ms. Clark said that patients with metastatic colorectal cancer should be monitored for evidence of GI perforation and wound dehiscence while NSCLC patients are at risk for life-threatening hemoptysis and bleeding. Severe hypertension, proteinuria, and congestive heart failure have also been reported. She noted that bevacizumab is not approved for squamous cell NSCLC and is not usually given to those patients because squamous cell tumors are centrally located near main blood vessels, putting these patients at high risk for life-threatening hemoptysis.

Most bevacizumab patients benefit greatly from the drug and do not have serious problems. Ms. Clark described a retrospective chart review of 20 lung cancer patients: 17 received bevacizumab plus standard chemotherapy and 3 received bevacizumab alone. Of these 20 patients, 7 had no adverse events, 3 had minor bleeding, 3 had hypertension that was managed with antihypertensives, 2 had thromboembolic events, and 1 had a brief, non-life-threatening hemoptysis. That patient discontinued the drug, as did 3 others, mostly due to fatigue.

The recommended nursing assessment includes careful investigation of concurrent medications (eg, nonsteroidal anti-inflammatory drugs, which increase bleeding risk); urinalysis to check for proteinuria; monitoring for hypersensitivity reactions; and blood pressure monitoring. Ms. Clark said that if blood pressure rises above 150/100 mm Hg, the physician should be notified to reevaluate the use of bevacizumab in the patient.

Due to the increased risk of wound dehiscence associated with bevacizumab, Ms. Clark said that current recommendations are to delay the start of therapy until 28 days after surgery and to reevaluate the surgical wound regularly.