Cizumab 400mg (Bevacizumab)

DESCRIPTION

Bevacizumab is a drug sold under the name of Cizumab  and which is categorized as monoclonal anti-body & anti-angiogenesis When Cizumab  concomitant use with human monoclonal antibody IgG1, that circumstance and prohibits the biological action of human vascular endothelial growth factor (VEGF).

INDICATION

Cizumab  is indicated for the treatment of some of the conditions like :

Metastatic colon or rectal cancer

Non-squamous, non-small cell lung cancer

Glioblastoma

Metastatic renal cell cancer

Metastatic cervical cancer

Epithelial ovarian, fallopian tube or peritoneal cancer

MECHANISM OF ACTION

Cizumab  comprises an active compound like Bevacizumab which binds to VEGF and avoid the communication of VEGF to its receptors like Flt-1 & KDR) present on the surface of the cells
This interaction prevents endothelial cell multiplication and new blood vessel production occurs
Hence in counts cessation of metastatic cancer cells development happens

PHARMACOKINETICS

DISTRIBUTION

The volume of distribution is 2.9 (22%) L

ELIMINATION

The Bevacizumab half-life period is 20days (11 to 50days)

DOSAGE MANAGEMENT

Key point:
Avoid administration of Cizumab  before at least 28 days following surgery and the wound is completely cured
colorectal carcinoma:
Concomitant use with 5-fluorouracil based chemotherapy is the usual dosage of Cizumab : While concomitant use with bolus IFL the dose is 5mg/kg of Cizumab  for every 2 weeks IV.
While in combination with FOLFOX4 the dose is 10mg/kg of Cizumab  for every 2 weeks IV
5mg/kg IV Cizumab  for every 2 weeks or 7.5 mg/kg Cizumab  as IV every 3 weeks by concurrently used with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy
Non-small cell lung cancer:
While combining with carboplatin and paclitaxel: The Cizumab  usual dosage is 15mg/kg IV for every 3 weeks by
Glioblastoma:
For every 2 weeks: 10mg/kg of Cizumab  administered IV
Metastatic renal cell cancer:
Concurrent use with interferon alfa: The Cizumab usual dosage is 10mg/kg IV for every 2 weeks
Metastatic cervical cancer:
Combining with paclitaxel and cisplatin or with paclitaxel and topotecan: The drug Cizumab  usual dosage is 15mg/kg of Cizumab  given intravenously for every 3 weeks
Epithelial ovarian, fallopian tube or peritoneal cancer:
Platinum opposing:
Concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan: TheCizumab  regular dosage is 10mg/kg of Cizumab  for every 2 weeks
Or Combining with topotecan: The Cizumab  regular dosage 15mg/kg of Cizumab  given through IV for every 3 weeks
Platinum responsive:
concomitant with carboplatin and paclitaxel for 6 to 8 cycles: The drug Cizumab  recommended dosage of is 15mg/kg given IV for 3 weeks
Combining with gemcitabine & carboplatin for 6 to 10 cycles: The Cizumab  recommended dosage is 15mg/kg of Cizumab  given IV for 3 weeks
Preparation & administration:
Cizumab  is intravenous solution
At initial infusion:
given IV infusion over 90 minutes
Following infusions:
give second infusion over 60 minutes, if tolerated
Administer all following infusion over 30minutes
Cizumab  IV infusion is prepared in aseptic condition
Cizumab  400mg containing 16ml solution whereas 100mg containing 4ml
Cizumab  dilute into 100ml of 0.9% NS
Do not dilute with dextrose solution
Dispose the remaining portion of medicine which is left in a vial.

PRECAUTIONS

There are some complications occurred during treatment with Cizumab , care should be taken
Arterial thromboembolic events: cessation of treatment with Cizumab  in patients who are suffered with severe ATE.
Venous thromboembolic events: Toxicity Incidence should be detected; If severe condition therapy should be stopped.
Hemorrhage: While on Cizumab  treatment some Serious hemorrhages will occur like GI hemorrhage, hemoptysis, Hematemesis, CNS hemorrhage, nose bleeding & vaginal bleeding. Hence Discontinue the treatment.
Hypertension: Bp is increased in patients who are receiving Cizumab  therapy, must be frequently check up with blood pressure and provided with alternative medication for correct the pressure.
In hypertension crisis or encephalopathy should be discontinue the treatment.
Posterior reversible encephalopathy syndrome
Embryo fetal toxicity occurs:During pregnancy condition Cizumab  is contraindicated which produce fetal harm.
Ovarian failure: The patients who are receiving Cizumab  may have a chance of getting ovarian failure.
Congestive heart failure: the drug combination with anthracycline based chemotherapy, treatment with Cizumab  must not be used.
Cizumab  treatment should be stopped while CHF occurs.

SIDE EFFECTS

• Gastrointestinal perforation and fistulae
  • Surgery and wound healing complication
  • Hemorrhage
  • Arterial thromboembolic events
  • Venous thromboembolic events
  • Hypertension
  • Posterior reversible encephalopathy syndrome
  • Renal injury & Proteinuria
  • Infusion reactions
  • Ovarian failure
  • Congestive heart failure
  • Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysesthesia.

DRUG INTERACTION

While interaction of Cizumab  with paclitaxel & carboplatin, causes reduce in exposure of paclitaxel after four cycles of treatment.

Interaction with paclitaxel &carboplatin cause to increase the paclitaxel exposure at day 6

CONTRAINDICATIONS

No contraindication occurred In some case the patients who are contraindicated to any component of Cizumab  may occur hypersensitivity.

PREGNANCY 

Pregnancy category: D
While administrating Cizumab  in pregnant women, positive evidence on fetal risk depends on human studies but potential benefits by using the drug may have common risk against fetus.

LACTATION

Cizumab  is excreted into breast milk taking account on this, discussion should do on whether to discontinue the breast feeding or the drug. The drug is risky during mother breast feeding to their infants.

STORAGE 

The drug stored at 2 to 8°C(36 to 46°F).
Single use vial
Dispose the left-out vial under the guidance of pharmacists.

MISSED DOSE

The dose missed by patient should have the dose immediately before the next dose timing reaches or leave the missed dose and continue the regular schedule.
Remember do not have double dose at a time
Please consult with doctor for further details.