In focus: targeted therapies - bevacizumab ('Avastin')

[OvacomeSupport]

Hello, everyone

This month in our Health in Focus series, we’ll be looking at targeted therapies. Cancer cells behave differently from healthy cells in a number of ways. These behaviours can make them more vulnerable to damage. Targeted therapies are drugs that disrupt this abnormal behaviour, causing the cells to die.

Targeted therapies are usually given in addition to surgery and chemotherapy for ovarian cancer, as maintenance therapies. Their role is to reduce the risk of the cancer recurring and to prolong the time between treatments if it does. This can give people longer periods of feeling well before they next need treatment.

Because targeted therapies are less likely to affect healthy cells, many people find that their side effects are more tolerable than chemotherapy and become easier to manage over time. As with any drug, some people will find them easier to tolerate than others. If you’re experiencing side effects that are difficult to cope with, your team may be able to reduce the dose, which can make them more manageable

Our information booklet about targeted therapies is available at:

ovacome.org.uk/targeted-the...

In this first post in our series on targeted therapies, we will be focusing on drugs that interfere with tumours’ ability to form a blood supply (angiogenesis inhibitors). In particular, we will be looking at bevacizumab (‘Avastin.’) We’ll start by talking about the availability of the drug, how it’s given and its potential side effects and then we’ll give an outline of how it works.

For ovarian cancer, Avastin is available first line in England (via the Cancer Drugs Fund to people who meet certain criteria) and Scotland. It isn’t currently available in Wales and Northern Ireland. Other drugs with a similar way of working are being developed, but at the moment they’re only available for ovarian cancer through clinical trials.

Avastin is usually started alongside chemotherapy and given every three weeks for 18 cycles. Because it affects the blood vessels, Avastin can cause problems with wound healing. Your team will therefore wait until you’ve recovered from your surgery before starting it.

Avastin is given through a drip, so most people will have it in hospital. It normally takes about 30 minutes for each dose, but the first two doses are usually given over 90 and 60 minutes so that the nurses can make sure that you’re tolerating the medication well. Allergic reactions can occur, although they are rare and usually mild.

Side effects of Avastin include low white blood cells, leading to increased risk of infections, low red blood cells (anaemia), causing tiredness and breathlessness, bleeding such as nosebleeds, and high blood pressure. If you suspect that you may have an infection or if you start coughing or vomiting blood, develop unexpected vaginal bleeding or see blood in your stools, you should seek urgent medical advice.

There are other possible side effects of Avastin, and you can find a more detailed list in the links at the end of this post. If you develop any side effects, your team will be able to advise you on how to manage them.

The process Avastin targets is angiogenesis. This is where tumours can only grow to a few millimetres in size before they need their own blood supply in order to continue growing. A tumour gets its blood supply by growing it from a nearby blood vessel. It sends out chemical signals to the cells lining the vessel. The signal binds to the surface of the cell and tells it to grow a new blood vessel towards the tumour.

You can watch a short animation of this at:

youtube.com/watch?v=_qn_noi...(Not working as expected?)

Angiogenesis inhibitors are a type of drug that disrupts this process. The aim of treatment is to deprive the cancer cells of oxygen and nutrients, so the tumour stops growing or shrinks.

One of the chemical signals that cancer cells use is called vascular endothelial growth factor (‘VEGF’). Avastin sticks to the VEGF so that it can’t bind to the blood vessel cells and tell them to grow a new vessel.

You can find more information about Avastin at:

macmillan.org.uk/cancer-inf...

cancerresearchuk.org/about-...

If you would like to share your experiences of Avastin or have any tips on it, please comment on this post. If you would like information or support, please contact our Support Line on 07503 682 311 or email [e-mail].

Best wishes

Julia (Ovacome Support Services Officer)

[Katmal-UK]

Hi I trialled Avastin back in 2007/08. I found it very tolerable. I had the infusion every 3rd Wednesday for a year (originally alongside chemo). I then went back to work the next day (working full time). I found the 'worst' side effects were the aches and pains in my legs and the congested nasal passages which also mean that after blowing my nose each morning I would have a slight nose bleed. The congestion lasted at least 3 months after stopping the Avastin, the aches and pains went a lot quicker. I did achieve a complete remission of nearly 4.5 years with a good quality of life. xx Kathy xx

[OvacomeSupport Partner My Ovacome Team in reply to Katmal-UK]

Hello Kathy

Thank you very much for your helpful reply sharing your experiences of Avastin.

Best wishes

Julia

[Summergold2]

I am currently on Avastin about 1/2 way through dose 11. My oncologist is doing 22 cycles. So far the only side affect has been high blood pressure that has been mitigated by BP medicine. I do get tired sometimes but then I just rest. After being diagnosed in Dec 2019, 51/2 hours surgery, chemo with the continuation of Avastin......I was diagnosed in “ remission” Aug 31. I will finish my Avastin somewhere in April 2021. I am excited and amazed at the prospect of longer remission times or even hopefully no reoccurrence....fingers crossed. Thank you to all the research’s, doctors, nurses, drug companies for giving us the chance of a longer life. I only wish ALL women could benefit.

Fighting the fight,

Debbie

[OvacomeSupport Partner My Ovacome Team in reply to Summergold2]

Dear Debbie

Thank you for taking the time to share your experience of Avastin. I hope the rest of the treatment goes well.

Best wishes

Anna

Ovacome Support

[JayGeeCee]

I had Avastin alongside my last three infusions of Carbo Taxol and the continued 3 weekly infusions for about 9 months. I finished in January 2019.

I found Avastin tolerable- high blood pressure and nosebleeds. I also missed a couple of sessions because my blood test results were not favorable.

Realised about 6 months ago that I felt “normal “ (whatever that is).

Diagnosed three years ago, currently CA125 is 8, so feeling hopeful.

Here in France we are lucky not to have to meet criteria and the drug is automatically offered.

Joy

[OvacomeSupport Partner My Ovacome Team in reply to JayGeeCee]

Dear Joy

Thank you for taking the time to share how you found Avastin. It's great to hear how well you are doing.

Best wishes

Anna

Ovacome Support

[W6W3]

Good morning ladies . Iam on avastin . Next week will be my 16 cycle. I feel a little tired after it and the next day but then fine . My feet and legs ache and I get headaches but that is soon sorted with paracetamol. Iam going back to work at the end of the month after 9 rounds of chemo and surgery. Here’s to getting my life back 😃

[OvacomeSupport Partner My Ovacome Team in reply to W6W3]

Hello W6W3

Thank you for letting us know about your experience. Good luck with returning to work!

Best wishes

Anna

Ovacome Support

[Ruebacelle]

I had avastin post surgery. 1st 3 with carbo then alone and it put me in remission for 14 months. Sude effects not significant but here in france they dont let you repeat after 1st series which is a shame.

[OvacomeSupport Partner My Ovacome Team in reply to Ruebacelle]

Dear Ruebacelle

Thank you very much for sharing your experience.

Best wishes

Anna

Ovacome Support

[Natsmb]

I was on avastin from Sep.2018- July 2020. I received an infusion for every 3 weeks for almost a total of 30 cycles.

Initially, the avastin, which I took without any support drugs, brought my numbers down. Then they stabilized. At the time I stopped the treatment, the numbers were progressing incrementally. The doctors were actually pleased with the situation. It was holding pretty well.

I'm pleased to see avastin has worked for many people. It's an effective drug in many cases. I had a really hard time with it myself after the first few cycles.

I had much the same side effects as others in this post. My nose seem to be chronically stuffy and infected, aches and pains, myalgia etc. I also experienced a great deal of cramping in my leg muscles and hip muscles. And I often felt a lot of pain and burning in my ligaments and joints.

About 8 months into the treatment, I began to have avastin related inflammation in my heart muscles and around my heart sack. I had a lot of fluid buildup period after being treated for that which was fairly simple, I also started to deal with a pulmonary effusion which did not get diagnosed for almost 6 months afterwards. In the end I had a surgery and then a pluerex catheter put in. For me, the muscle inflammation, cramping, and plural effusion problems seem to compound and after every treatment, the cramping and pain seemed a little more intense and to last a little longer. By my last session I had not had a single day without this severe cramping and severe inflammation. I was bedridden most of the time. I had to take myself off even though Avastin was definitely keeping the disease stable. If I could have tolerated the side effects I would still be on it I am sure. I do know several people who have been on avastin for a fair amount of time, (not quite as long as I was), who appeared to be tolerating it quite well.

Most patients are seldom on the drug itself period it is given alongside other d therapy drugs. I forget why I was on avastin by itself but there was a very good reason. I know that after hearing all the details I made the decision to take just avastin.

I have been off avastin since July. The muscle cramping and chronic nose cold, and a fair amount of the inflammation have calmed down a little.

[OvacomeSupport Partner My Ovacome Team in reply to Natsmb]

Dear Natsmb

Thank you very much for taking the time to share your experience of Avastin. I'm so sorry to hear you had such significant and debilitating side effects. As you rightly point out, side effects can vary a great deal between different people. I'm glad your inflammation and other side effects seem to be lessening now. If there is any information you need or anything we can help with, please do get in touch.

Best wishes

Anna

Ovacome Support

[Spes]

After nearly a year on Avastin my blood pressure shot up to dangerous levels almost overnight, and investigations showed serious kidney damage (egfr less than 20). This is an unusual but known side-effect, and I would urge people on Avastin to ask for regular kidney-function tests. In my case I was treated by a nephrologist who managed to improve my kidney function, but it'll never be what it was. Needless to say I'm now off Avastin, which is a shame as it was doing a good job inhibiting the growth of the tumour...

[OvacomeSupport Partner My Ovacome Team in reply to Spes]

Dear Spes

Thank you for sharing your experience of Avastin. I'm sorry to hear you had such significant side effects. Thank you for highlighting the issue for forum members.

Best wishes

Anna

Ovacome Support