25 mg / mL concentrate for infusion solution 
bevacizumab

Read all of this leaflet carefully before you start using this medicine. It contains information that is important to you.

  • Save this information, you may need to read it again.
  • If you have any further questions, ask your doctor, pharmacist, or nurse.
  • If you get any side effects, talk to your doctor, pharmacist or nurse. This also applies to any side effects not mentioned in this information. See section 4.

In this leaflet: 
1. What Avastin is and what it is used for 
2. What you need to know before you use Avastin 
3. How to use Avastin 
4. Possible side effects 
5. How to store Avastin 
6. Contents of the packaging and other information 

1. What Avastin is and what it is used for

Avastin contains the active substance bevacizumab, which is a humanized monoclonal antibody (a type of protein normally produced by the immune system to help protect the body against infections and cancer). Bevacizumab selectively binds to a protein called VEGF ( human vascular endothelial growth factor), which is found inside the body’s blood and lymph vessels. VEGF protein causes blood vessels to grow in tumors and these blood vessels supply the tumor with nutrients and oxygen. When bevacizumab is bound to VEGF, tumor growth is prevented by blocking the growth of the blood vessels that supplytumor one with nutrients and oxygen.

Avastin is a medicine used to treat adult patients with advanced colon or rectal cancer. Avastin is given together with chemotherapy that contains fluoropyrimidine.

Avastin is also used to treat adult patients with metastatic (spread) breast cancer. When used in patients with breast cancer, it will be given with a cytostatic drug called paclitaxel or capecitabine.

Avastin is also used to treat adult patients with advanced non-small-cell lung cancer. Avastin is then given together with a chemotherapy treatment that contains platinum.

Avastin is also used to treat adult patients with advanced non-small-cell lung cancerwhen the cancer cells have a specific mutation in a protein called epidermal growth factor receptor (EGFR). Avastin is then given together with erlotinib.

Avastin is also used to treat adult patients with advanced kidney cancer. When Avastin is used in patients with kidney cancer, it will be given another type of medicine called interferon.

Avastin is also used to treat adult patients with advanced ovarian, fallopian tube, or primary peritoneal cancer. Avastin should be used in combination with carboplatin and paclitaxel in the treatment of patients with ovarian, fallopian tube, or primary peritoneal cancer.

When used in adult patients with an advanced ovarian, fallopian tube, or primary peritoneal cancer whose disease has returned at least 6 months after the last time they were treated with platinum-containing chemotherapy, Avastin will be given in combination with carboplatin and gemcitabine or with carboplatin and paclitaxel.

When used in adult patients with advanced ovarian, fallopian tube, or primary peritoneal cancer whose disease has returned earlier than 6 months after the last time they were treated with platinum-containing chemotherapy, Avastin will be given in combination with paclitaxel, or topotecan, or pegylated liposomal doxorubicin.

Avastin is also used to treat adult patients with residual, recurrent, or metastatic cervical cancer. Avastin is then given in combination with paclitaxel and cisplatin, alternatively paclitaxel and topotecan in patients who cannot receive platinum treatment.

2. What you need to know before using Avastin

Do not use Avastin

  • if you are allergic (hypersensitive) to bevacizumab or any of the other ingredients of this medicine (listed in section 6).
  • if you are allergic (hypersensitive) to products from Chinese hamster ovary (CHO) cells or recombinant human or humanized antibodies.
  • if you are pregnant.

Warnings and cautions

Talk to your doctor, pharmacist, or nurse before using Avastin.

  • It is possible that Avastin may increase the risk of developing cavities in the intestinal wall. If you have diseases that cause inflammation inside the abdomen (eg diverticulitis, stomach ulcers, colitis associated with chemotherapy), tell your doctor.
  • Avastin may increase the risk of developing an abnormal connection or passage between two organs or blood vessels (such a connection is called a fistula ). The risk of developing connections between the vagina and any part of the intestine may increase if you have residual, recurrent, or metastatic cervical cancer.
  • This medicine may increase the risk of bleeding or increase the risk of problems with wound healing after surgery. If you are going to have surgery, if you have undergone major surgery within the last 28 days or if you still have unhealed surgical wounds, you should not use this medicine.
  • Avastin may increase the risk of developing serious skin infections or underlying layers of the skin, especially if you have had a hole in the intestinal wall or problems with wound healing.
  • Avastin may increase the incidence of high blood pressure . If you have high blood pressure that is not well controlled by your blood pressure medication, talk to your doctor as it is important to make sure your blood pressure is under control before starting treatment with Avastin.
  • If you have or have had an aneurysm (enlargement and weakening of a vessel wall) or a rupture in a vessel wall.
  • This medicine increases the risk of getting protein in your urine, especially if you are already suffering from high blood pressure.
  • The risk of getting blood clots in your arteries (a type of blood vessel) can increase if you are over 65, if you have diabetes, or if you have previously had blood clots in your arteries. Talk to your doctor as blood clots can lead to heart attack and stroke.
  • Avastin may also increase the risk of developing blood clots in your veins (a type of blood vessel).
  • This medicine can cause bleeding, especially tumor-related bleeding. Talk to your doctor if you or your family seem to be suffering from bleeding problems or if for any reason you are taking medication to thin your blood.
  • It is possible that Avastin may cause bleeding in and around your brain. Discuss this with your doctor if you have widespread cancer that affects your brain.
  • It is possible that Avastin may increase the risk of bleeding in your lungs, including coughing and spitting blood. Talk to your doctor if you have noticed this before.
  • Avastin may increase the risk of developing a weak heart. It is important that your doctor knows if you have ever received anthracyclines (eg doxorubicin, a special type of chemotherapy used to treat certain cancers) or have had radiation therapy to your chest, or if you have heart disease.
  • This medicine can cause infections and a decrease in the number of neutrophils (a type of blood cell that is important for your protection against bacteria).
  • Avastin may cause hypersensitivity and/or infusion reactions (reactions related to your injection of this medicine). Tell your doctor, pharmacist, or nurse, if you have previously had problems after the injection, such as dizziness/fainting, shortness of breath, swelling, or rash.
  • A rare neurological side effect called posterior reversible encephalopathysyndrome (PRES) has been associated with Avastin treatment. If you have headaches, vision changes, confusion, or seizures with or without high blood pressure, consult your doctor.

Contact your doctor even if these statements above only applied to you earlier in your life.

Before you receive Avastin or while you are being treated with Avastin:

  • If you have or have had pain in your mouth, teeth and/or jaw, swelling or tenderness inside your mouth, numbness or a feeling of heaviness in your jaw, or if a tooth becomes loose, talk to your doctor and dentist immediately.
  • If you need to have dental treatment or dental surgery, tell your dentist that you are being treated with Avastin, especially if you are also receiving or have been given intravenous bisphosphonates.

You may be advised to have your teeth examined before starting treatment with Avastin.

Children and young people

The use of Avastin in children and adolescents under 18 years of age is not recommended as safety and benefit have not been established in these patient groups.

Bone tissue death ( osteonecrosis ) in bones other than the jaw has been reported in patients under 18 years of age treated with Avastin.

Other medicines and Avastin

Tell your doctor, pharmacist, or nurse if you are taking, have recently taken, or might take any other medicines.

Combining Avastin with another medicine called sunitinib malate (prescribed for kidney and gastrointestinal cancers) can cause serious side effects. Talk to your doctor to make sure you are not combining these medicines.

Tell your doctor if you are using platinum- or taxane-based treatment for lung or spread breast cancer. These treatments in combination with Avastin may increase the risk of serious side effects.

Tell your doctor if you have recently received, or are receiving, radiation therapy.

Pregnancy, breastfeeding and fertility

You must not use Avastin if you are pregnant. Avastin can harm your unborn baby as it can prevent the formation of new blood vessels. Your doctor should advise you to use contraception during treatment with Avastin and for at least 6 months after the last dose of Avastin.

Tell your doctor immediately if you are pregnant, becoming pregnant during treatment with this medicine, or planning to become pregnant in the near future.

You must not breast-feed during treatment with Avastin and for at least 6 months after the last dose of Avastin as this medicine may interfere with the growth and development of your baby.

Avastin may impair female fertility. Contact your doctor for more information.

Consult a doctor, pharmacist, or nurse before taking any medicine.

Driving and using machines

Avastin has not been shown to reduce your ability to drive or use tools or machines. However, drowsiness and fainting have been reported with the use of Avastin. If you experience symptoms that affect your vision, concentration, or ability to react, do not drive or use machines until the symptoms have disappeared.

Important information about some of the ingredients of Avastin

This medicine contains less than 1 mmol sodium (23 mg) per vial, ie essentially ‘ sodium-free’. is almost “sodium-free”.

3. How to use Avastin

Dosage and dosing frequency

Dose one of Avastin depends on your body weight and the type of cancer to be treated. The recommended dose is 5 mg, 7.5 mg, 10 mg, or 15 mg per kg of your body weight. Your doctor will prescribe the Avastindos that is right for you. You will be treated with Avastin once every two or three weeks. The number of infusions you receive depends on how you respond to the treatment; you should continue to use this medicine until Avastin can no longer prevent your tumor from growing. Your doctor will discuss this with you.

Method of administration

Avastin is a concentrate for infusion solution. Depending on the dose prescribed by your doctor, some or all of the contents of the Avastin vial will be diluted with sodium chloride (saline) solution before use. A doctor or nurse will give you the diluted Avastin solution as an intravenous infusion (a drip into a vein). The first infusion will be given over 90 minutes. If you tolerate this well, the second infusion will be given for 60 minutes. Later infusions can be given for 30 minutes.

Avastin treatment should be temporarily discontinued

  • if you develop severe high blood pressure that requires treatment with blood pressure medication,
  • if you have problems with wound healing after surgery,
  • if you are having surgery.

Avastin treatment should be stopped completely if you develop it

  • severe high blood pressure that cannot be controlled with blood pressure medication; or a sudden increase in blood pressure,
  • protein in the urine and at the same time swelling in the body,
  • a hole in your intestinal wall,
  • an abnormal tube-like connection or passage between the trachea and esophagus, between internal organs and the skin, between the vagina and any part of the intestine or between other tissues that are not normally connected to each other ( fistula ), and which your doctor considers serious,
  • severe infection of the skin or underlying layers of the skin,
  • a blood clot in your arteries,
  • a blood clot in the blood vessels of the lungs,
  • any severe bleeding.

If you get more Avastin than you should

  • you may develop severe migraines. If this happens, talk to your doctor, pharmacist, or nurse immediately.

If an Avastindos is missed

  • Your doctor will decide when to take your next dose of Avastin. You should discuss this with your doctor.

If you stop using Avastin

Discontinuation of your treatment with Avastin may stop the effect on your tumor growth. Do not stop taking Avastin unless you have discussed this with your doctor.

If you have any further questions on the use of this product, ask your doctor, pharmacist or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you get any side effects , talk to your doctor, pharmacist or nurse. This also applies to any side effects not mentioned in this information.

The side effects listed below were seen when Avastin was given with chemotherapy. This does not necessarily mean that these side effects are caused by Avastin.

Allergic reactions

If you get an allergic reaction, tell your doctor or healthcare professional immediately. These signs may include difficulty breathing or chest pain. You may also have redness or rash, chills, and tremors, nausea or vomiting.

You should seek immediate help if you get any of the side effects listed below.

The serious side effects, which can be very common (may affect more than 1 user in 10), include:

  • high blood pressure,
  • feeling of numbness or tingling in the hands or feet,
  • decreased number of blood cells in the blood, including white blood cells that help protect against infection (this can occur along with fever), and platelets that help the blood to clot,
  • feeling weak and lacking in energy,
  • fatigue,
  • diarrhea, nausea, vomiting, and abdominal pain.

The serious side effects, which can be common (may affect up to 1 in 10 people in 100), include:

  • holes in the intestine,
  • bleeding, including bleeding in the lungs of patients with non-small-cell lung cancer ,
  • blocking of arterial engines with a blood clot,
  • blockage of the veins with a blood clot,
  • blockage of the blood vessels in the lungs with a blood clot,
  • blockage of the veins in the legs with a blood clot,
  • heart failure ,
  • problems with wound healing after surgery,
  • redness , flaking of the skin, tenderness, pain, or blisters on fingers or feet,
  • decreased number of red blood cells in the blood,
  • lack of energy,
  • gastrointestinal problems,
  • muscle and joint pain, muscle weakness,
  • dry mouth in combination with thirst and / or decreased or dark-colored urine,
  • inflammation of the mucous membranes of the mouth and stomach, lungs and airways, reproductive organs and urinary tract,
  • sores in the mouth and esophagus, which can be painful and cause difficulty swallowing,
  • pain, including headache, back pain, and pain in the pelvis and anal region,
  • localized warp formation,
  • infection, and in particular infection of the blood or bladder,
  • decreased blood supply to the brain, or stroke (blood clot in the brain or cerebral hemorrhage),
  • somnolence,
  • nosebleed,
  • increase in heart rate ( pulse one),
  • blocked gastrointestinal passage,
  • abnormal urine samples ( protein in the urine),
  • shortness of breath or low oxygen levels in the blood.
  • skin infections or infection are in the deeper layers under the skin,
  • fistula: an abnormal tube-like connection between internal organs and skin or other tissues that are not normally connected to each other, including connections between the vagina and the intestine in patients with cervical cancer.

Serious side effects with an unknown frequency (cannot be calculated from the available data) include:

  • severe infection of the skin or underlying layers of the skin, especially if you have had a hole in the abdominal wall or problems with wound healing,
  • allergic reactions (signs may include difficulty breathing, flushing, rash, low or high blood pressure, low blood oxygen level, chest pain, or nausea/vomiting),
  • a negative effect on women’s ability to have children (see below section after the list of side effects for further recommendations),
  • a condition of the brain with symptoms that include seizures (seizures), headaches, confusion and changes in vision (posterior reversible encephalopathysyndrome or PRES),
  • signs indicating changes in normal brain function (headache, vision changes, confusion or seizures) and high blood pressure,
  • An enlargement and weakening of a vessel wall or a rupture in a vessel wall ( aneurysms and arterial dissections),
  • blood clots in very small blood vessels in the kidney,
  • abnormally high blood pressure in the blood vessels in the lungs which causes the right side of the heart to work harder than normal,
  • a hole in the septum (the cartilage wall that separates the nostrils) in the nose,
  • a hole in the stomach or intestine,
  • an open sore or hole in the lining of the stomach or small intestine (signs may include abdominal pain, feeling bloated, black tarry stools or blood in the stools, or bloody vomiting),
  • bleeding from the lower part of the colon,
  • gums in the gums with an exposed jawbone that does not heal and may be associated with pain and inflammation in the surrounding tissue (see the section below for the list of side effects for further recommendations),
  • holes in the gallbladder (symptoms and signs may include abdominal pain, fever, and nausea/vomiting).

You should seek help as soon as possible if you experience any of the following side effects.

The very common (may affect more than 1 in 10 users) side effects that were not serious include:

  • constipation,
  • loss of appetite,
  • fever,
  • eye problems (including increased tear flow),
  • speech disorders,
  • change of taste,
  • Runny nose,
  • dry skin, flaking and inflammation of the skin, change in skin color,
  • weight loss,
  • nosebleeds.

The most common (may affect up to 1 in 10 users in 100) side effects that were not serious include:

  • voice change and hoarseness.

Patients older than 65 years have an increased risk of experiencing the following side effects:

  • blood clots in the artery engines which can lead to stroke (cerebral hemorrhage or thrombus) or heart attack,
  • a decrease in the number of white blood cells in the blood and a decrease in the number of platelets that help the blood to clot,
  • diarrhea,
  • feeling sick,
  • headache,
  • fatigue,
  • high blood pressure .

Avastin may also cause changes in laboratory tests performed by your doctor. These include decreased white blood cell counts, especially neutrophils (a type of white blood cell that helps protect against infections ) in the blood, protein in the urine, decreased blood potassium, sodium or phosphorus (a mineral) in the blood, elevated blood sugar, elevated alkaline phosphatase (an enzyme ) in the blood, elevated serum creatinine (a protein measured by a blood test to check how your kidneys are working), decreased hemoglobin (found in red blood cells and carrying oxygen), which can be serious.

Pain in the mouth, teeth and/or jaw, swelling or tenderness inside the mouth, numbness or a feeling of heaviness in the jaw, or if a tooth becomes loose. These may be signs and symptoms of damage to the jawbone ( osteonecrosis ). Tell your doctor and dentist immediately if you experience any of them.

Fertile women (women who have a regular menstrual cycle) may notice that their period becomes irregular or absent and may notice impaired fertility. If you are considering having children, discuss this with your doctor before starting treatment.

Avastin has been developed and manufactured to treat cancer by injection into the bloodstream. It has not been developed or manufactured for injection into the eye. It is therefore not approved for use in this way. When Avastin is injected directly into the eye (unauthorized use) the following side effects may occur:

  • Infection or inflammation of the eyeball,
  • Redness of the eye, small particles or dots / spots in the field of vision , eye pain,
  • To see flashes of light in connection with dots/spots, which turns into a certain loss of vision,
  • Increased pressure in the eye,
  • Bleeding in the eye.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly to the Medical Products Agency, www.lakemedelsverket.se. By reporting side effects, you can help increase drug safety information. 

5. How to store Avastin

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the outer carton and on the vial label after the abbreviation EXP. The expiration date is the last day of the specified month.

Store in a refrigerator (2 ° C – 8 ° C).

Do not freeze.

Keep the vial in the outer carton. Sensitive to light.

Infusion solutions should be used immediately after dilution. If it is not used immediately, the responsibility for shelf life and storage lies with the user. This storage should normally not be longer than 24 hours at 2 ° C to 8 ° C unless the solution has been prepared under controlled and validated aseptic conditions. Once diluted in a sterile environment, Avastin is stable for 30 days at 2 ° C to 8 ° C plus a further 48 hours at 2 ° C to 30 ° C.

Do not use Avastin if you notice particles or discoloration before administration.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Contents of the packaging and other information

Content declaration

  • The active substance is bevacizumab. Each ml of concentrate contains 25 mg of bevacizumab, equivalent to 1.4 to 16.5 mg/ml when diluted as recommended. 
    Each 4 ml vial contains 100 mg of bevacizumab, equivalent to 1.4 mg/ml when diluted as recommended. 
    Each 16 ml vial contains 400 mg of bevacizumab, equivalent to 16.5 mg/ml when diluted as recommended.
  • The other ingredients are trehalose dihydrate, sodium phosphate, polysorbate, and water for injections.

What the medicine looks like and contents of the pack

Avastin is a concentrate for solution for infusion . The concentrate is a clear, colorless to slightly brown liquid in a glass vial with a rubber stopper. Each vial contains 100 mg bevacizumab in 4 ml solution or 400 mg bevacizumab in 16 ml solution.

Marketing Authorisation Holder

Roche Registration GmbH

Emil-Barell-Strasse 1

79639 Grenzach-Wyhlen

Germany

Manufacturer

Roche Pharma AG, Emil-Barell-Str. 1, 79639 Grenzach-Wyhlen, Germany.

For any information about this medicine, please contact the local representative of the Marketing Authorization Holder:

Belgium / Belgique / BelgienNV Roche SATel: +32 (0) 2 525 82 11 LithuaniaUAB “Roche Lietuva”Tel: +370 5 2546799
BulgariaRosh BULGARIA LOODETel: +359 2 818 44 44 Luxembourg / Luxemburg(See / See Belgium / Belgium)
Czech RepublicRoche sroTel: +420 – 2 20382111 HungaryRoche (Hungary) Kft.Tel: +36 – 23 446 800
DenmarkRoche a / sTel: +45 – 36 39 99 99 Malta(See Ireland)
GermanyRoche Pharma AGTel: +49 (0) 7624 140 The NetherlandsRoche Nederland BVTel: +31 (0) 348 438050
EestiRoche Eesti OÜTel: + 372 – 6 177 380 NorwayRoche Norge ASTel: +47 – 22 78 90 00
GreeceRoche (Hellas) AE:Ηλ: +30 210 61 66 100 AustriaRoche Austria GmbHTel: +43 (0) 1 27739
SpainRoche Farma SATel: +34 – 91 324 81 00 PolandRoche Polska Sp.z ooTel: +48 – 22 345 18 88
FranceRocheTel: +33 (0) 1 47 61 40 00 PortugalRoche Pharmacêutica Chemica, LdaTel: +351 – 21 425 70 00
CroatiaRoche dooTel: + 385 1 47 22 333 RomaniaRoche România SRLTel: +40 21 206 47 01
IrelandRoche Products (Ireland) Ltd.Tel: +353 (0) 1 469 0700 SloveniaRoche pharmacevtska družba dooTel: +386 – 1 360 26 00
IcelandRoche a / sc / o Icepharma hfTel: +354 540 8000 Slovak RepublicRoche Slovensko, sroTel: +421 – 2 52638201
ItalyRoche SpATel: +39 – 039 2471 Finland / FinlandRoche OyPuh / Tel: +358 (0) 10 554 500
ΎπροςΓ.Α.Σταμάτης & Σια Λτδ.:Ηλ: +357 – 22 76 62 76
LatviaRoche Latvija SIATel: +371 – 6 7 039831 United KingdomRoche Products Ltd.Tel: +44 (0) 1707 366000

Muhammad Nadeem

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