Bevacizumab (Avastin®)

Bevacizumab is a treatment that has been proved effective in treating some forms of cancer. However, the evidence for its effectiveness in treating brain tumour is not yet clear. For this reason, it is not licenced for the treatment of brain tumours in the UK.

It is, however, being used in some clinical trials e.g. for high grade gliomas in both adults and children, particularly in combination with chemotherapy and/or radiotherapy.

Its brand name is Avastin®.

What is Avastin?

Bevacizumab is a type of 'monoclonal antibody'.

Antibodies are naturally occurring proteins within our bodies that our immune system makes when it detects harmful substances. The antibodies work to remove or kill the harmful substances.

Researchers have learned how to make antibodies that detect specific substances, known as 'markers', on the surface of some tumour cells. When many exact copies of that antibody are made, they are called Monoclonal Antibodies (MABs).

How does it work?

Bevacizumab works by attaching itself to markers on the tumour cells' surface and blocking signals that help the cells to grow or divide.

Is bevacizumab effective for brain tumours?

Recurrent Glioblastomas

Some studies initially produced promising results in shrinking recurrent glioblastomas. These are glioblastomas (GBMs) that have returned after initial treatment.

This led to accelerated approval of the drug in the USA. However, in Europe it was felt that this shrinking could be due to bevacizumab's effect of reducing swelling in and around the tumour rather than shrinking the tumour itself. As a result, Europe (including the UK) have not authorised it for treatment of brain tumours.

New research is looking at following treatment with bevacizumab with a drug called dasatinib (Sprycel®). This is only available within clinical trials.

Newly diagnosed glioblastomas

Results from trials on newly diagnosed glioblastoma - some have shown no worsening of symptoms (known as 'progression-free survival'), but others have shown little or no effect.

There has been no effect on overall survival.

The evidence currently suggests it may not be suitable as first line use in newly diagnosed patients.

Other brain tumours

Research into whether bevacizumab is helpful in treating other brain tumours is ongoing within clinical trials. These include recurrent grade 2 and 3 gliomas, and grade 3 and 4 non-brainstem gliomas in children.

Can I have bevacizumab?

As it is not licensed in the UK, it is very unlikely that you will be able to have bevacizumab.

If your medical team believes it would benefit you, they may be able to help you to access to the drug via the following routes:

• Independent Funding Request - your clinician makes a request, on your behalf, to your local health body.
• Cancer Drugs Fund (England only) – bevacizumab is only on the list for third line use in low grade gliomas in children.
• Clinical trial- speak to your specialist about trials that may be suitable for you.
• 'Compassionate use' or 'off-label use'.
• Paying for it yourself.

If your medical team does not think bevacizumab would benefit you, you are entitled to request a second opinion from another health professional. Your GP or your neuro-oncologist can help to arrange this.

If I have bevacizumab

How will I take bevacizumab?

Bevacizumab is taken 'intravenously' i.e. directly into your vein, usually over a series of sessions every two to three weeks.

It is sometimes taken in combination with chemotherapy or radiotherapy.

What are the common side-effects?

The most common side-effects of bevacizumab include:

• hypertension (high blood pressure)
• fatigue
• constipation, diarrhoea and abdominal pain
• nosebleeds or rectal bleeding
• dry or inflamed skin
• back pain or headaches.

The most common serious side-effects of bevacizumab include:

• serious bleeding
• wounds that don't heal
• gastrointestinal perforation (hole in the stomach or intestine).

These side-effects can sometimes be life-threatening. Contact your health care team if you have any signs of side-effects, or any of the following:

• chest pain
• breathlessness
• difficulty speaking or moving
• changes in vision
• swelling, warmth or redness in an arm or leg.

Bevacizumab can also affect vaccinations, pregnancy, breast feeding and use of other medicines. Speak to your health team.