Zirabev (Bevacizumab) 100mg/4ml

 Antineoplastic; Monoclonal Antibody; Vascular Endothelial Growth Factor Inhibitor

CSA NA – FDA Approved – REMS (N) – Can Ship

Bevacizumab is a recombinant, humanized monoclonal antibody which bind and neutralizes vascular endothelial growth factor (VEGF) which prevents the proliferation and formation of new blood vessels.  The inhibition of microvascular growth is believed to retards cancerous growth, however it also been effective in treating tendinopathy.  Intratendinous injection of Bevacizumab has been shown to accelerate tendon healing in the early stages of tendinosis.

Officially indicated for various forms of cancer but is sometimes used off-label in sports medicine to treat tendinosis.

Do not use in patients with hypersensitivity or intolerant to pentoxifylline or other xanthines (i.e. 

Do not use in patients who have or develop GI perforation, tracheoesophageal fistula, fistula formation

Discontinue use in patients who develop heart failure

Discontinue use in patients who develop grade 3 or 4 hemorrhage

Discontinue use in patients who experience a hypertensive crisis

Discontinue use in patients who experience a severe infusion reaction and administer appropriate medical therapy

Discontinue use in patients who develop necrotizing fasciitis

Females of reproductive age should be informed of the potential risk of ovarian failure prior to Bevacizumab initiation

Discontinue use in patients who develop nephrotic syndrome

Do not use in patients with severe arterial thromboembolic events or venous thromboembolism

Tendinosis

IV: Off-Label dosing to be determined by medical doctor.

Note: Bevacizumab should never be administered within 28 days after surgery and healing of any surgical wound.

How is Avastin, Mvasi, Zirabev/Bevacizumab Given:  Is given by intravenous infusion with an initial dose given over 90 minutes.  The length of the infusion can be reduced on subsequent treatments if the initial infusion is well tolerated.  After tolerance at the 90-, 60-, and 30-minute infusion rates have been established, some infusion clinics may use an off-label 10-minute infusion rate (0.5mg/kg/minute).  Medical care staff must always closely monitor the patient for any signs/symptoms of an infusion reaction.  

Percentages reported as monotherapy and as part of combination chemotherapy regimens.  Some studies only reported hematologic toxicities grades ≥4 and nonhematologic toxicities grades ≥3.

>10%:

Cardiovascular: Hypertension (24% to 42%), peripheral edema (15%), venous thromboembolism (grades 3/4: 5% to 11%)

Central Nervous System: Fatigue (33% to 82%), headache (22% to 49%), dizziness (23%), insomnia (21%), anxiety (17%), myasthenia (13% to 15%), voice disorder (5% to 13%), dysarthria (8% to 12%), taste disorder

Dermatologic: Exfoliative dermatitis, xeroderma

Endocrine & Metabolic: Ovarian failure (34%), hyperglycemia (26%), hypomagnesemia (24%), weight loss (20% to 21%), hyponatremia (19%), hypoalbuminemia (16%)

Gastrointestinal: Nausea (53% to 72%), diarrhea (21% to 40%), decreased appetite (34% to 36%), stomatitis (15% to 25%), abdominal pain (grade 3/4: 8% to 12%)

Genitourinary: Urinary tract infection (22%), proteinuria (5% to 20%), pelvic pain (14%)

Hematologic & Oncologic: Thrombocytopenia (58%; grade 3/4: 20% to 40%), leukopenia (grades 3/4: 37% to 53%), pulmonary hemorrhage (4% to 31%), neutropenia (12%; grades ≥3: 8% to 21%), bruise (17%), lymphocytopenia (12%; grades 3/4: 6%), rectal hemorrhage

Neuromuscular & Skeletal: Arthralgia (28% to 41%), limb pain (19% to 25%), back pain (12% to 21%), myalgia (19%)

Ophthalmic: Disease of the lacrimal apparatus

Renal: Increased serum creatinine (16%)

Respiratory: Epistaxis (17% to 55%), dyspnea (26% to 30%), cough (26%), oropharyngeal pain (16%), sinusitis (15%)

Miscellaneous: Postoperative wound complication (5% to 15%)