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Bevacizumab (Avastin™)

Last Updated: 10/3/17

Status: Currently a NF2 Clinical Trial


  1. Basic Information
  2. Treatment Expectations
  3. Concerns
  4. Side Effects
  5. Other Uses for Avastin™
  6. Frequently Asked Questions
  7. Official Study Results So Far
  8. Sources

Also See: NF2 Informal Avastin Study

Bevacizumab (Avastin™) is a clinical trial treatment of a Chemotherapeutic Molecular Targeted Tumor Therapy. Avastin had been in use for Cancers conditions before the trial for Neurofibromatosis Type 2 (NF2). Schwannoma on the Vestibular Nerve, also known as Vestibular Schwannoma (VS) is the only tumor and location it had been found to have noticeable effects on since trials began in 2009. It was also the only tumor type at that location it was closely monitored for until 2015 when trial expanded for Meningioma and Ependymoma. No results shared for changes in Meningioma or Ependymoma can be found here at this time and assume for VS tumors only.

Individuals stay on Avastin™; 1) until side effects become dangerous or uncomfortable, 2) if breaks for other treatments for surgeries are necessary, 3) have stopped three months later if treatment proves ineffective, or 4) until the treatment is no longer necessary. Treatment may be proven ineffective if Avastin simply had no effect, but could also be a result of starting the treatment too late in tumor growth, the tumor may have already resulted in impossible to recover from nerve damage.

To date, a few have managed to have Avastin™ hold or slow down the growth of VS up to eight (8) years, but many stop the trial after two (2) years. A few left the trial for attempts at more effective trials, but in the last year, a few on Avastin starts a new trial of a combination of Avastin and other medications people have done well in trials in goals of better results.

Awareness of possible side effects helped allow the longer-term durations of continued treatment. Example: the requirement to drink more water to prevent dehydration.

Like all other tumor inhibitor treatments, Avastin™ is not yet approved by the Food and Drug Administration (FDA), or approved by any other country as an accepted, proven treatment for NF2 and is clinical trial only. More research is necessary, and additional treatments should also be considered.

1. Basic Information

Trade Name Avastin™
Other Names bevacizumab systemic, Allergan's Bevacizumab-aww (MVASI™)
Possible Replacement Biosimilar Treatment Allergan's: Bevacizumab-aww (MVASI™)
Pharmaceutical Companies Genentech / Roche
Prescription Information Genentech
NF2 Trial Availability Most Countries
Taken By Intravenous (IV) or Port
Tumor Target Vestibular Schwannoma and Ependymoma
NF2 Trials
Inhibitor VEGF-A Vascular Endothelial Growth Factor A (VEGF-A) an Angiogenesis Inhibitor
Molecular Formula C6638H10160N1720O2108S44
IUPAC Humanized anti-VEGF antibody

2. Concerns - Treatment Facts to be Aware of

Major side effects are uncommon. Since people with NF2 are taking these medications at a low dose, only minimal side effects are common. However, long term use is primarily where these major side effects take place. Monthly Blood and Urine Tests can usually point to an issue before it's a real problem. Talk to your doctor.

  1. Hydration: Many of the side effects below are hydration issues; drink as much water as you can.
  2. Kidney Failure: In a urine test, this can be found if there is too much protein in urine. Look for dark colored urine.
  3. Gastrointestinal Perforation: Hole in Stomach, Small or Large Intestines. Symptoms - Abdominal Pain, Nausea, Vomiting, Constipation and Fever.
  4. Severe Bleeding: Coughing up Blood, Bleeding in the Stomach, Vomiting Blood, Bleeding in the Brain, Nosebleeds and Vaginal Bleeding.
  5. Dry Eyes resulting in Cracked Cornea: Make sure eyes stay lubricated with eye drops of some sort. Not limited to patients with dry eye issues prior to taking medications, but all people with NF2.
  6. Nausea: Nausea is easily managed with Zofran.
  7. Premature Ovarian Failure(POF): Women should have FSH (Follicle-Stimulating Hormone) and Estradiol Levels regularly checked. - Learn More about POF

3. Side Effects

List of Most Common Issues

  • Dry Sinuses
  • Dry Eyes
  • Dry Skin
  • Dry Throat
  • Fatigue
  • Headaches
  • Impaired Wound Healing
  • Irregular Menstrual Cycle
  • Nausea
  • Skin Rash

Complete List

  • Dry Sinuses
  • Abdominal Pain
  • Back Pain
  • Bowel Perforation
  • Brain Bleeding
  • Cracked Cornea
  • Dry Eyes
  • Dry Skin
  • Dry Throat
  • Fatigue
  • Headaches
  • Heart Attack
  • Heart Problems
  • High Blood Pressure
  • Hoarseness Of Voice
  • Impaired Wound Healing
  • Inflammation Of The Nose
  • Irregular Menstrual Cycle
  • Leg Pain
  • Liver Failure
  • Liver Problems
  • Mouth Sores
  • Nasal Septum Perforations
  • Nausea
  • Nephrotic Syndrome
  • Nose Bleeds
  • Premature Ovarian Failure
  • Protein In Urine
  • Rectal Bleeding
  • Sensitive Tongue
  • Skin Rash
  • Stroke
  • Taste Change
  • Tear Production Disorder

4. Other Uses for Avastin™

Treatment for:

  • Advanced nonsquamous non-small cell lung cancer (NSCLC)
  • Metastatic colorectal cancer (mCRC)
  • Metastatic kidney cancer (mRCC)
  • Glioblastoma Multiforme (GBM)
  • Breast Cancer, Metastatic
  • Colorectal Cancer
  • Glioblastoma Multiforme
  • Macular Degeneration
  • Malignant Glioma
  • Neurofibromatosis Type 1
  • Non-Small Cell Lung Cancer
  • Ovarian Cancer
  • Pancreatic Cancer
  • Renal Cell Carcinoma
  • Solid Tumors

5. Frequently Asked Questions

Issue 1: What Tumors Might Change?

Avastin™ does not help everyone. It would be unknown which tumors might be affected, by what percentage and possible none.

Issue 2: Side Effect Concerns?

Side effects are generally minimal, tests can be done to stop in to manage issues to prevent them from becoming worse. However this often requires lowering dose or stopping treatment of Avastin™.

Issue 3: How soon before surgery do I need to stop Avastin™?

  • Before: If surgery is required, a wait would be required of two months before surgery would be possible. This wait could give tumors time to do more damage.
  • After: A break after surgery is also be required to properly recover before it would be safe to start again. It can take as little as one month to recover from surgery, but can take up to 3 years to completely heal from certain nerve damage. Avastin™ is known to result in lowering wound healing ability and could minimize the amount of healing after surgery if started to soon.
  • Other Issues: Breaks in treatment of Avastin™, for even a few months, have resulted in increased tumor growth where tumors have regrown back to the original size they were prior to starting Avastin™.

6. Avastin Studies Results so Far

There appears to be stabilisation of index tumour growth and at times regression of tumour while on Bevacizumab. There is symptomatic benefit for patients in parallel for both vestibular and peripheral schwannomas. [Smole, Z. et al., 2014]

7. Sources

  1. Plotkin, S. R., Stemmer-Rachamimov, A. O., Barker, F. G., Halpin, C., Padera, T. P., Tyrrell, A., ... & di Tomaso, E. "Hearing improvement after bevacizumab in patients with neurofibromatosis type 2." New England Journal of Medicine (2009)361(4), 358-367.
    Source: http://www.nejm.org/doi/full/10.1056/NEJMoa0902579

  2. Jeyaretna, D. S., Curry, W. T., Batchelor, T. T., Stemmer-Rachamimov, A., & Plotkin, S. R. "Exacerbation of cerebral radiation necrosis by bevacizumab." Journal of Clinical Oncology 29(7), e159-e162. (2011)
    Source: http://jco.ascopubs.org/content/29/7/e159.short

  3. Plotkin, S. R., Merker, V. L., Halpin, C., Jennings, D., McKenna, M. J., Harris, G. J., & Barker, F. G. . "Bevacizumab for progressive vestibular schwannoma in neurofibromatosis type 2: a retrospective review of 31 patients." Otology & Neurotology 33(6), 1046-1052. (2012)
    Source: http://journals.lww.com/otology-neurotology/Abstract/2012/08000/Bevacizumab_for_Progressive_Vestibular_Schwannoma.25.aspx

  4. Smole, Z., Thoma, C. R., Applegate, K. T., Duda, M., Gutbrodt, K. L., Danuser, G., & Krek, W. . "Tumor suppressor NF2/merlin is a microtubule stabilizer." Cancer Research, 74(1), 353-362. (2014)
    Source: http://www.neurology.org/content/82/10_Supplement/P3.326.short