TECENTRIQ + Avastin® (bevacizumab) Offers a Same-Day Dosing Schedule

A combination therapy with consistent, q3w infusions 1,9

Dosing information for Avastin is based on the IMbrave150 trial; TECENTRIQ was administered q3w in IMbrave150. Visualization of vials is illustrative and does not represent actual vial usage.
IV=intravenous; q2w=every 2 weeks; q3w=every 3 weeks; q4w=every 4 weeks.
 

  • TECENTRIQ should be administered first, followed by Avastin
  • Administer the initial infusion of TECENTRIQ over 60 minutes; if the first infusion is tolerated, all subsequent infusions may be delivered over 30 minutes
  • If Avastin is discontinued, TECENTRIQ can be administered as 840 mg q2w, as 1200 mg q3w, or as 1680 mg q4w
  • Do not administer TECENTRIQ as an IV push or bolus
  • Do not co-administer other drugs through the same IV line
  • Administer Avastin as an IV infusion
  • First infusion of Avastin: administer infusion over 90 minutes
  • Subsequent infusions: administer second infusion over 60 minutes if first infusion is tolerated. Administer all subsequent infusions over 30 minutes if second infusion over 60 minutes is tolerated
  • Refer to the Avastin Prescribing Information for Avastin dosage modifications for specific adverse reactions. No dose reductions for Avastin are recommended
Select Important Safety Information for Avastin 9
  • An evaluation for the presence of varices is recommended within 6 months of initiation of Avastin in patients with HCC
  • There is lack of clinical data to support the safety of Avastin in patients with history or risk of variceal bleeding

Dosage modifications from the TECENTRIQ Prescribing Information 1*

No dose reduction for TECENTRIQ is recommended. In general, withhold TECENTRIQ for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue TECENTRIQ for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating steroids.

Dosage modifications for TECENTRIQ for adverse reactions that require management different from these general guidelines are summarized in the following table:
 

Adverse reaction
Severity
Dosage modification
Pneumonitis
Grade 2 
Withhold
Grade 3 or 4
Permanently discontinue
Colitis Grade 2 or 3 Withhold
Grade 4 Permanently discontinue
Hepatitis with no tumor involvement of the liver
AST or ALT >3 and ≤8 times ULN
or
Total bilirubin >1.5 and ≤3 times ULN
Withhold
AST or ALT >8 times ULN
or
Total bilirubin >3 times ULN

Permanently discontinue
Hepatitis with tumor involvement of the liver§
Baseline AST or ALT >1 and ≤3 times ULN and increases to >5 and ≤10 times ULN
or
Baseline AST or ALT >3 and ≤5 times ULN and increases to >8 and ≤10 times ULN
Withhold
AST or ALT >10 times ULN
or
Total bilirubin >3 times ULN
Permanently discontinue
Endocrinopathies
Grade 3 or 4
Withhold until clinically stable or permanently discontinue depending on severity
Nephritis with renal dysfunction
Grade 2 or 3 increased blood creatinine
Withhold
Grade 4 increased blood creatinine
Permanently discontinue
Exfoliative dermatologic conditions
Suspected SJS, TEN, or DRESS
Withhold
Confirmed SJS, TEN, or DRESS Permanently discontinue
Myocarditis Grade 2, 3, or 4 Permanently discontinue
Neurological toxicities Grade 2 Withhold
Grade 3 or 4 Permanently discontinue
Infusion-related reactions
Grade 1 or 2
Interrupt or slow the rate of infusion
Grade 3 or 4
Permanently discontinue 


ALT=alanine aminotransferase; AST=aspartate aminotransferase; DRESS=drug rash with eosinophilia and systemic symptoms; SJS=Stevens-Johnson syndrome; TEN=toxic epidermal necrolysis; ULN=upper limit of normal.
*Refer to the Prescribing Information for other medications for dosage modification and AR management.
Graded per National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (NCI CTCAE v4.0).
Resume in patients with complete or partial resolution (grade 0-1) after corticosteroid taper. Permanently discontinue if no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids.
§If AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue TECENTRIQ based on recommendations for hepatitis with no liver involvement.