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VEGFR Monoclonal Antibody

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VEGFR Monoclonal Antibody, Bevacizumab, Avastin, Ramucirumab, Cyramza

  • See Also
  1. VEGFR Inhibitor
  2. Tyrosine Kinase
  3. Monoclonal Antibody-Mediated Chemotherapy
  4. Chemotherapy
  5. Monoclonal Antibody
  • Indications
  1. Colorectal Cancer (metastatic, advanced or unresectable)
    1. Bevacizumab
    2. Ramucirumab
  2. Non-Small Cell Lung Cancer
    1. Bevacizumab
    2. Ramucirumab
  3. Glioblastoma (recurrent)
    1. Bevacizumab
  4. Renal Cell Carcinoma (metastatic)
    1. Bevacizumab
  5. Cervical Cancer (advanced, recurrent)
    1. Bevacizumab
  6. Ovarian Cancer, Fallopian Tube Cancer or Primary Peritoneal Cancer (resistant)
    1. Bevacizumab
  7. Hepatocellular Carcinoma
    1. Bevacizumab
    2. Ramucirumab
  8. Gastric Cancer (advanced)
    1. Ramucirumab
  9. Soft-Tissue Sarcoma
    1. Bevacizumab (off-label)
  10. Age-Related Macular Degeneration
    1. See VEGF Inhibitor Intravitreal Injection
    2. Bevacizumab (off-label)
  • Mechanism
  1. Vascular Endothelial Growth Factor Receptor (VEGF, VEGFR)
    1. See Tyrosine Kinase
    2. Angiogenesis signaling Protein
      1. Vascular Endothelial Growth Factors (VEGF) are pro-angiogenic Cytokines
      2. Bind to VEGF receptors on Tyrosine Kinases to initiate Angiogenesis
      3. Target in some Targeted Cancer Therapy (as below)
    3. Other functions
      1. Monocyte activation and differentiation (VEGFR 1)
      2. Also used in Age-Related Macular Degeneration as a VEGF Inhibitor Intravitreal Injection
  2. VEGFR Inhibitors
    1. VEGF Inhibitors suppress Angiogenesis
    2. Recombinant Monoclonal Antibody against Vascular Endothelial Growth Factor (VEGF)
    3. Inhibit VEGF receptor binding, interfering with the growth and maintenance of neoplastic vessels
  3. Other Inhibitors of VEGFR
    1. See Small Molecule VEGF Inhibitor
  • Medications
  1. Bevacizumab (Avastin) IV Infusion
    1. Risk of CV events, VTE, bleeding, MAHA, GI perforation, Proteinuria, Hypertension, poor Wound Healing
  2. Ramucirumab (Cyramza) IV Infusion
  • Dosing
  1. See other references for disease specific dosing protocols
  • Adverse Effects
  1. General
    1. Infusion Reaction (Bevacizumab, Ramucirumab)
    2. Poor Wound Healing and wound dehiscence (Bevacizumab, Ramucirumab)
      1. Avoid Bevacizumab for 28 days before elective surgery and at least 28 days after surgery
  2. Cardiovascular
    1. Arterial Thrombosis including TIA/CVA, MI (Bevacizumab, Ramucirumab)
    2. Severe Hypertension including PRES (Bevacizumab, Ramucirumab)
    3. Congestive Heart Failure (Bevacizumab)
  3. Hematologic
    1. Venous Thromboembolism (Bevacizumab)
    2. Microangiopathic Hemolytic Anemia or MAHA (Bevacizumab, Ramucirumab)
    3. Hemorrhage (Bevacizumab, Ramucirumab)
  4. Gastrointestinal
    1. Gastrointestinal perforation or fistula (Bevacizumab, Ramucirumab)
    2. Exacerbation of hepatic Impairment in patients with cirrhosis Child-Pugh B or C (Ramucirumab)
  5. Renal
    1. Proteinuria including Nephrotic Syndrome (Bevacizumab, Ramucirumab)
  6. Endocrine
    1. Premature Ovarian Failure with Impaired future fertility (Bevacizumab)
    2. Thyroid dysfunction (Ramucirumab)
  7. Other common reported adverse effects
    1. Headache
    2. Epistaxis
    3. Exfolliative dermatitis
    4. Back pain
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters, Pregnancy category X)
    1. Use reliable Contraception
  3. Monitoring
    1. Blood Pressure
    2. Urinalysis
    3. Thyroid Function Tests (Ramucirumab)
  • Drug Interactions
  1. Anticoagulation
    1. Higher risk of bleeding and thrombosis while on Venous Thromboembolism treatment (Bevacizumab)
  2. Sunitinib
    1. Avoid in combination with Bevacizumab
  • Resources
  1. Bevacizumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=939b5d1f-9fb2-4499-80ef-0607aa6b114e
  2. Ramucirumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c6080942-dee6-423e-b688-1272c2ae90d4
  • References
  1. Adams (2005) Nat Biotechnol 23:1147-57 [PubMed]
  2. Smith (2021) Am Fam Physician 103(3): 155-63 [PubMed]