Management of toxicity in patients receiving therapy with bevacizumab

Bevacizumab has been administered to more than 200,000 cancer patients globally. This wealth of information has demonstrated that bevacizumab-associated adverse events are similar across indications. Commonly reported events with bevacizumab are hypertension (in up to 34% of patients), proteinuria (in up to 38% of patients) and haemorrhage (mucocutaneous haemorrhage in 20–40% of patients), most of which are grade 1–2 in severity. Less frequent events include arterial and venous thromboembolic events (ATEs, VTEs), congestive heart failure/cardiomyopathy, wound-healing complications and gastrointestinal perforations. These bevacizumab-associated events have also been reported in two phase III trials of bevacizumab in combination with chemotherapy (capecitabine [AVF2119g] or paclitaxel [E2100]) in advanced breast cancer. Overall, these adverse events are not dose-related in any indication (except for hypertension and grade 1 proteinuria). Furthermore, the most frequently reported bevacizumab-associated adverse events are mild/moderate in severity and are easily managed. Recommendations for the management of bevacizumab-related adverse events include regular monitoring (hypertension, proteinuria); use of standard care (hypertension, VTEs); temporary dose interruption (hypertension, proteinuria, VTEs, wound healing) to permanent discontinuation of treatment (for all severe events).