Overview
Bevacizumab (Avastin) is an antibody that targets vascular endothelial growth factor (VEGF). It may be effective against a number of solid tumors, but it is also associated with a number of serious toxicities, one of which is excessive bleeding.
Risk factors for excessive bleeding during bevacizumab therapy:
(1) concurrent thrombocytopenia
(2) concurrent antiplatelet drugs and/or anticogulants
(3) tumor cavitation or ulceration
(4) type of tumor (non-small cell lung cancer, renal cell carcinoma, colon cancer)
(5) surgery or trauma
(6) high dose bevacizumab therapy
Recommendations:
(1) Identify other risk factors for bleeding.
(2) Avoid a high dose of bevacizumab if possible.
(3) Discontinue the bevacizumab 6-8 weeks prior to any planned surgery.
(4) Avoid medications that may contribute to a bleeding tendency. If anticoagulation is necessary, make sure that the patient is monitored and that the dose is as low as possible.
