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Angiogenesis inhibitors: Nursing Pharmacology



bevacizumab (Avastin, Mvasi, Zirabev)
*High Alert Medication*

Angiogenesis inhibitor
Binding to VEGF → inhibit angiogenesis, ultimately reducing cancer progression
  • Cancer treatment (e.g., non-small cell lung cancer, cervical cancer, metastatic colorectal cancer, metastatic renal cell carcinoma, recurrent glioblastoma)
  • Macular degeneration
  • IV
  • Intravitreal
  • Headaches, dizziness, syncope
  • Injection-site reactions
  • Exfoliative dermatitis
  • Abdominal pain, anorexia, nausea, vomiting, diarrhea
  • Heart failure, hypertension, venous thromboembolism
  • Thrombocytopenia, leukopenia
  • Increased risk of infections
  • Dyspnea
  • Epistaxis, hemoptysis, vaginal bleeding
  • Gastrointestinal perforation and bleeding
  • Wound dehiscence
  • Serious bleeding
  • Hypertensive crisis
  • Use 28 days before and after surgery
  • Pregnancy and breastfeeding
  • Children and elderly clients
  • Cardiovascular or thromboembolic disease
Assessment & monitoring: Bevacizumab for recurrent glioblastoma

  • Current symptoms: headaches, seizures, nausea, vision changes
  • Neurologic status
  • Weight
  • Vital signs
  • Laboratory test results: liver and renal function tests, uric acid, electrolytes, CBC, urinalysis
  • Diagnostic test results:  electrocardiogram, CT, MRI, PET, biopsy; negative pregnancy test 

  • Emergency equipment readily available
  • Patent intravenous access
  • Stay with your client for the first 15 minutes
    • Watching for signs of infusion reaction: pruritus, chills, dyspnea, tachycardia, vomiting
    • Stop the infusion and contact the healthcare provider if infusion reaction if suspected 

  • Side effects
  • Evaluate desired therapeutic effects: decreased tumor size and abated cancer progression
  • Purpose of medication: impairs tumor blood supply by preventing the formation of new blood vessels
  • Administered by IV infusion
  • Side effects
    • Nausea, vomiting, anorexia: eat small, frequent meals; maintain hydration
    • Report
      • Heart failure: weight gain of more than two pounds in a day or four pounds in a week
      • Infection: sore throat, fever, chills, or cough
        • Take measures to reduce infection risk
      • Thrombocytopenia: bleeding gums, nosebleeds, black stools, vomit that looks like coffee grounds, easy bruising
      • Venous thromboembolism: swelling with redness or pain in one leg, chest pain, difficulty breathing, coughing up blood, trouble speaking or swallowing

Content Reviewers:

Lisa Miklush, PhD, RNC, CNS

Angiogenesis inhibitors are medications mainly used to treat cancers like non-small cell lung cancer, cervical cancer, metastatic colorectal cancer, metastatic renal cell carcinoma, and recurrent glioblastoma. In addition, these medications can be used to treat macular degeneration.

The most commonly used angiogenesis inhibitor is bevacizumab, which is a monoclonal antibody that’s administered intravenously for cancer treatment, and intravitreal for macular degeneration. Once administered, bevacizumab acts by binding to the protein human vascular endothelial growth factor, or VEGF for short, which helps promote angiogenesis, meaning the formation of new blood vessels throughout the body. So, bevacizumab inhibits the activity of VEGF, ultimately reducing the progression of cancer or macular degeneration.

Now, bevacizumab may often lead to side effects, such as headaches, dizziness, or syncope. In addition, some clients may present with injection-site infusion reactions or exfoliative dermatitis. Other common side effects include abdominal pain, anorexia, nausea, vomiting, or diarrhea.

Clients on bevacizumab may also develop heart failure, hypertension, and venous thromboembolism; as well as thrombocytopenia, leukopenia, and increased risk of infections. Additional side effects include dyspnea, epistaxis, hemoptysis, and vaginal bleeding. Finally, bevacizumab can potentially cause gastrointestinal perforation and bleeding, as well as wound dehiscence.

Regarding contraindications, bevacizumab should be used with caution in clients with serious bleeding or hypertensive crisis, and it should not be used 28 days before and after surgery, since it can interfere with wound healing. In addition, bevacizumab should be used cautiously during pregnancy and breastfeeding, as well as in children and elderly clients. Other precautions include clients with cardiovascular or thromboembolic disease.

Okay, when caring for a client prescribed bevacizumab for recurrent glioblastoma, start by performing a baseline assessment. Ask your client about symptoms related to their glioblastoma, such as headaches, seizures, vision changes, or nausea. Next, perform an assessment with focused attention on their neurologic status, in addition to collecting their vital signs, and obtain your client’s weight to ensure accurate dosing.

Lastly, review their most recent laboratory test results, including liver and renal function tests, uric acid, electrolytes, CBC, and urinalysis; as well as diagnostic test results, including electrocardiogram, CT, MRI, PET, and biopsy; and confirm a negative pregnancy test as needed.

Moving on to client education, teach your client how bevacizumab prevents the formation of new blood vessels, which stops their tumor’s blood supply and ultimately reduces its growth. In addition, explain how they will need to receive an intravenous infusion of bevacizumab every 2 weeks, and stress the importance of adhering to their dosing schedule.