Bevacizumab injection is available as several different products that are considered to be biologic medications (medications made from living organisms). These biosimilar products are highly similar to bevacizumab injection and work the same way as bevacizumab injection in the body. Therefore, the term bevacizumab injection products will be used to represent these medications in this discussion.

Bevacizumab injection products are used in combination with other chemotherapy medications to treat certain types of colon and rectal cancer (cancer that begins in the large intestine), non-small cell lung cancer (NSCLC), glioblastoma (a certain type of cancerous brain tumor), renal cell cancer (RCC, a type of cancer that begins in the kidney), cervical cancer (cancer that begins in the opening of the uterus [womb]), and ovarian (female reproductive organs where eggs are formed), fallopian tube (tube that transports eggs released by the ovaries to the uterus), or peritoneal (layer of tissue that lines the abdomen) cancer. Bevacizumab (Avastin) is also used in combination with atezolizumab (Tecentriq) to treat hepatocellular carcinoma (HCC) that has spread or cannot be removed by surgery in people who have not previously received chemotherapy. Bevacizumab injection products are in a class of medications called antiangiogenic agents. They work by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.

Bevacizumab injection products come as a solution (liquid) to administer slowly into a vein. Bevacizumab injection products are administered by a doctor or nurse in a medical office, infusion center, or hospital. Bevacizumab injection products are usually given once every 2 or 3 weeks. Your dosing schedule will depend on the condition that you have, the other medications you are using, and how well your body responds to treatment.

It should take 90 minutes for you to receive your first dose of a bevacizumab injection product. A doctor or nurse will watch you closely to see how your body reacts to bevacizumab. If you do not have any serious problems when you receive your first dose of a bevacizumab injection product, it will usually take 30 to 60 minutes for you to receive each of your remaining doses of the medication.

Bevacizumab injection products may cause serious reactions during infusion of the medication. If you experience any of the following symptoms, tell your doctor immediately: difficulty breathing or shortness of breath, chills, shaking, sweating, headaches, chest pain, dizziness, feeling faint, flushing, itching, rash, or hives. Your doctor may need to slow down your infusion, or delay or stop your treatment if you experience these or other side effects.

Bevacizumab injection (Avastin) is also sometimes used to treat wet age-related macular degeneration (AMD; an ongoing disease of the eye that causes loss of the ability to see straight ahead and may make it more difficult to read, drive, or perform other daily activities) and diabetic macular edema (an eye disease caused by diabetes that can lead to vision loss). Talk to your doctor about the risks of using bevacizumab to treat your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before receiving a bevacizumab injection product,

• tell your doctor and pharmacist if you are allergic to bevacizumab, bevacizumab-adcd, bevacizumab-awwb, bevacizumab-bvzr, bevacizumab-maly, bevacizumab-tnjn, any other medications, or any of the ingredients in bevacizumab injection products.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have ever been treated with radiation therapy to the left side of your chest or pelvis; and if you have or have ever had bleeding problems, diabetes, high blood pressure, heart failure, angina (chest pain that comes at rest with no obvious cause), heart attack, stroke or transient ischemic attacks (TIA), or blood clots in your lungs or legs. Also, tell your doctor if you have recently coughed up blood.
• you should know that bevacizumab injection products may cause infertility in women (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant. Tell your doctor if you are pregnant or plan to become pregnant. You should use birth control to prevent pregnancy during your treatment with a bevacizumab injection product and for at least 6 months after your final dose. If you become pregnant while using a bevacizumab injection product, call your doctor. Bevacizumab may harm the fetus and increase the risk of a pregnancy loss.
• tell your doctor if you are breastfeeding. You should not breastfeed during your treatment with a bevacizumab injection product and for at least 6 months after your final dose.
• you should know that this medication may cause ovarian failure. Talk to your doctor about the risk of infertility in women caused by bevacizumab.
• tell your doctor if you have recently had surgery or if you plan to have surgery, including dental surgery. If you are scheduled to have surgery, your doctor will stop your treatment with an bevacizumab injection product at least 28 days before the surgery. If you have recently had surgery, you should not receive an bevacizumab injection product until at least 28 days have passed and until the area has completely healed.

Unless your doctor tells you otherwise, continue your normal diet.

If you miss an appointment to receive a dose of a bevacizumab injection product, call your doctor as soon as possible.

Bevacizumab injection products may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• loss of appetite
• heartburn
• change in ability to taste food
• diarrhea
• weight loss
• sores in the mouth
• voice changes
• increased or decreased tears
• stuffy or runny nose
• muscle, joint, or back pain
• trouble sleeping
• dry skin

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• nosebleeds or bleeding from your gums; coughing up or vomiting blood or material that looks like coffee grounds; unusual bleeding or bruising; increased menstrual flow or vaginal bleeding; pink, red, or dark brown urine; or red or tarry black bowel movements
• headache, dizziness, or weakness
• slow or difficult speech
• faintness
• weakness or numbness of an arm or leg
• chest pain or discomfort
• pain in the arms, shoulders, neck, jaw, stomach, or upper back
• shortness of breath
• seizures
• extreme tiredness
• confusion
• change in vision or loss of vision
• sore throat, fever, chills, and other signs of infection
• swelling of the face, eyes, stomach, hands, feet, ankles, or lower legs
• unexplained weight gain
• foamy urine
• pain, tenderness, warmth, redness, or swelling in one leg only
• rash or redness, itching, or scaling of the skin
• stomach pain, constipation, nausea, vomiting, shivering, or fever

Bevacizumab injection products may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor. Your doctor will check your blood pressure and test your urine regularly during your treatment with a bevacizumab injection product.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Alymsys^® (bevacizumab-maly)
• Avastin^® (bevacizumab)
• Avziva^® (bevacizumab-tnjn)
• Mvasi^® (bevacizumab-awwb)
• Vegzelma^® (bevacizumab-adcd)
• Zirabev^® (bevacizumab-bvzr)