AVASTIN CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/4ML [SIN13065P]

Product Info

AVASTIN CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/4ML

[SIN13065P]

3.1 Therapeutic Indications
Metastatic carcinoma of the colon or rectum(mCRC)
Avastin in combination with fluoropyrimidine-based chemotherapy is indicated for treatment of patients with metastatic carcinoma of the colon or rectum.

Metastatic Breast Cancer (mBC)
Avastin in combination with paclitaxel is indicated for the treatment of patients who have not received chemotherapy for metastatic HER2-negative breast cancer.

Avastin in combination with capecitabine is indicated for first-line treatment of patients with HER2-negative metastatic breast cancer in whom treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate. Patients who have received taxane and anthracycline-containing regimens in the adjuvant setting within the last 12 months should be excluded from treatment with Avastin in combination with capecitabine.

The effectiveness of Avastin in metastatic breast cancer (mBC) is based on an improvement in progression-free survival. Currently, no data are available that demonstrate an improvement in disease-related symptoms or increased survival with Avastin in breast cancer.

Non-Small Cell Lung Cancer (NSCLC)
Avastin, in combination with carboplatin and paclitaxel, is indicated for first-line treatment of patients with unresectable, locally advanced, recurrent or metastatic non-squamous, non-small cell lung cancer.
Avastin, in combination with erlotinib, is indicated for first-line treatment of patients with unresectable advanced, metastatic or recurrent non-squamous non-small cell lung cancer with Epidermal Growth Factor Receptor (EGFR) activating mutations.

Malignant Glioma (WHO Grade IV) – Glioblastoma
Avastin, as a single agent is indicated for the treatment of patients with glioblastoma after relapse or disease progression following prior therapy.
The effectiveness of Avastin in glioblastoma is based on an improvement in objective response rate. There are no data demonstrating an improvement in disease-related symptoms or increased survival with Avastin.

Advanced and/or metastatic Renal Cell Cancer (mRCC)
Avastin in combination with interferon alfa-2a is indicated for first-line treatment of patients with advance and/or metastatic renal cell cancer.

Epithelial Ovarian, Fallopian Tube and Primary Peritoneal Cancer
Avastin, in combination with carboplatin and paclitaxel is indicated for the front-line treatment of advanced (FIGO stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer.
Avastin, in combination with carboplatin and gemcitabine or in combination with carboplatin and paclitaxel is indicated for the treatment of patients with recurrent, platinum-sensitive, epithelial ovarian, fallopian tube, or primary peritoneal cancer who have not received prior bevacizumab or other VEGF-targeted angiogenesis inhibitors.
Avastin in combination with paclitaxel, topotecan or pegylated liposomal doxorubicin is indicated for the treatment of patients with recurrent, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor-targeted agents.

Cervical Cancer
Avastin in combination with paclitaxel and cisplatin or paclitaxel and topotecan is indicated for the treatment of persistent, recurrent, or metastatic carcinoma of the cervix.

3.2 Dosage and Method of Administration
Substitution by any other biological medicinal product requires the consent of the prescribing physician.
The safety and efficacy of alternating or switching between Avastin and products that are biosimilar but not deemed interchangeable to Avastin has not been established. Therefore, the benefit/risk of alternating or switching need to be carefully considered.
Avastin should be prepared by a healthcare professional using aseptic technique. Withdraw the volume of Avastin equivalent to the required dose per body weight and dilute in a total volume of 100 ml of sterile, pyrogen-free 0.9% sodium chloride. For further instructions, see section 5.4 Special Remarks – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information.
No incompatibilities between Avastin and polyvinyl chloride or polyolefin bags have been observed.
Avastin infusions should not be administered or mixed with dextrose or glucose solutions (see section 5.2 Incompatibilities – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
Do not administer as an intravenous push or bolus.
The initial Avastin dose should be delivered over 90 minutes as an intravenous infusion. If the first infusion is well tolerated, the second infusion may be administered over 60 minutes. If the 60-minute infusion is well tolerated, all subsequent infusions may be administered over 30 minutes.
The initial dose of Avastin should be administered following chemotherapy, all subsequent doses can be given before or after chemotherapy.
Avastin is not formulated for intravitreal use. (see section 3.4 Special Warnings and Special Precautions for Use – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information)

3.2.1 Standard Dosage
Metastatic carcinoma of the colon or rectum (mCRC)
The recommended dose of Avastin, administered as an intravenous infusion, is as follows:

First-line treatment: 5 mg/kg of body weight given once every 2 weeks or 7.5 mg/kg of body weight given once every 3 weeks.

Second-line treatment: 10 mg/kg of body weight given every 2 weeks with FOLFOX-4.
5mg/kg every 2 weeks or 7.5mg/kg every 3 weeks when used in combination with fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line Avastin-containing regimen (see section 4.1.2 study ML18147 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

It is recommended that Avastin treatment be continued until progression of the underlying disease. Patients previously treated with Avastin can continue with Avastin treatment following first progression (see section 4.1.2 study ML18147 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Metastatic breast cancer (mBC)
The recommended dose of Avastin, administered as an intravenous infusion, is as follows:
In combination with paclitaxel: 10 mg/kg of body weight given once every 2 weeks
In combination with capecitabine: 15 mg/kg of body weight given once every 3 weeks
It is recommended that Avastin treatment be continued until progression of the underlying disease.

Non-small cell lung cancer (NSCLC)
First-line treatment of NSCLC in combination with platinum-based chemotherapy
Avastin is administered in addition to platinum-based chemotherapy for up to 6 cycles of treatment followed by Avastin as a single agent until disease progression.
The recommended dose of Avastin is 15mg/kg of body weight given once every 3 weeks as an intravenous infusion.

First-line treatment of NSCLC with EGFR activating mutations in combination with erlotinib
The recommended dose of Avastin when used in addition to erlotinib is 15 mg/kg of body weight given once every 3 weeks as an intravenous infusion.
It is recommended that the treatment with Avastin in addition to erlotinib is continued until disease progression.
Please refer to the full prescribing information for erlotinib for patient selection and posology.

Malignant Glioma (WHO Grade IV) – Glioblastoma
The recommended dose of Avastin is 10 mg/kg of body weight given once every 2 weeks. It is recommended that Avastin treatment be continued until progression of the underlying disease.

Advanced and/or metastatic Renal Cell Cancer (mRCC)
The recommended dose of Avastin is 10 mg/kg of body weight given once every 2 weeks as an intravenous infusion.
It is recommended that Avastin treatment be continued until progression of the underlying disease.

Epithelial Ovarian, Fallopian Tube and Primary Peritoneal Cancer
The recommended dose of Avastin administered as an intravenous infusion is as follows.

Front-line treatment:
15 mg/kg of body weight given once every 3 weeks when administered in addition to carboplatin and paclitaxel for up to 6 cycles of treatment followed by continued use of Avastin as single agent until disease progression or for a maximum of 15 months or until unacceptable toxicity, whichever occurs earlier.

Treatment of recurrent disease:

Platinum sensitive:
15 mg/kg of body weight given once every 3 weeks when administered in combination with carboplatin and paclitaxel for 6 cycles and up to 8 cycles followed by continued use of Avastin as a single agent until disease progression.
Alternatively, 15 mg/kg every 3 weeks when administrated in combination with carboplatin and gemcitabine for 6 cycles and up to 10 cycles followed by continued use of Avastin as single agent until disease progression.

Platinum resistant:
10 mg/kg body weight given once every 2 weeks when administered in combination with one of the following agents

• paclitaxel, topotecan (given weekly) or pegylated liposomal doxorubicin (see section 4.1.2 Study MO22224 for chemotherapy regimens – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Alternatively, 15 mg/kg every 3 weeks when administered in combination with topotecan given on days 1 – 5, every 3 weeks (see section 4.1.2 Study MO22224 for chemotherapy regimen – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
It is recommended that treatment be continued until disease progression.

Cervical Cancer
The recommended dose of Avastin is 15 mg/kg every 3 weeks as an intravenous infusion administered in combination with one of the following chemotherapy regimens: paclitaxel and cisplatin, or paclitaxel and topotecan (see section 4.1.2 study GOG-0240 for further details on the chemotherapy regimens – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
It is recommended that Avastin treatment be continued until progression of the underlying disease.

3.2.2 Special Dosage Instructions
Pediatric Use: The safety and efficacy of Avastin in children and adolescents (<18 years) have not been established (see section 3.5 Use in Special Populations – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Avastin is not recommended for use in children and adolescents due to a lack of data on safety and efficacy (see also section 4.2.6 Nonclinical Safety – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Geriatric Use: No dose adjustment is required in patients ≥ 65 years of age. However, there was an increased risk of adverse events in patients above 65 years of age (See section 3.7.1 Elderly patients – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Renal impairment: The safety and efficacy of Avastin have not been studied in patients with renal impairment.

Hepatic impairment: The safety and efficacy of Avastin have not been studied in patients with hepatic impairment.

3.3 Contraindications
Avastin is contraindicated in:

• Patients with known hypersensitivity to any components of the product

• Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanised antibodies.

• Pregnancy