Overview | Schedule | Side Effects | Monitoring | Tips | Patient Assistance | Emotional Wellness | Drugs | References
Treatment Name: Bevacizumab (Avastin®) + Temozolomide (Temodar®)
Bevacizumab (Avastin®) + Temozolomide (Temodar®) is a Chemotherapy Regimen for Brain Cancer
What is High-Grade Glioma Brain Cancer?
High-grade gliomas consist of glioblastoma multiforme, a disease of the glial cells, and anaplastic astrocytoma, a disease of astrocytes, which are found in the brain. High grade gliomas are a rare condition. In most cases, the cause of high-grade glioma brain cancer is not known; however, they can arise from other low-grade brain cancers. Gliomas are classified into four grades (I, II, III, and IV), of which grades III and IV are considered to be high-grade.
How does bevacizumab + temozolomide work?
Bevacizumab stops the growth of blood vessels that supply nutrition to tumor cells. Temozolomide is designed to kill and slow growth of cancer cells in the brain.
Goals of therapy:
Bevacizumab + temozolomide is given to shrink tumors and decrease symptoms of high grade glioma brain cancer. Bevacizumab + temozolomide is not commonly given with the goal of cure but can potentially improve symptoms and prolong life.
How is bevacizumab + temozolomide therapy for high-grade glioma given?
- Bevacizumab I.V. over 90 minutes on Day 1 of Cycle 1
- then over 60 minutes for Cycle 2, if no infusion reactions occur
- then over 30 minutes for Cycles 3 and on, if no infusion reactions occur
- Temozolomide one or more capsules by mouth once daily on Days 1 through 21
Estimated total infusion time for this treatment:
- Up to 1.5 hours for Cycle 1, Day 1; Up to 1 hour for Cycle 2, Day 1; as short as 30 minutes for the first day of Cycle 3 and beyond if well tolerated
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time
Bevacizumab is usually given in an outpatient infusion center, allowing the person to go home afterwards. Temozolomide is usually taken at home.
Bevacizumab + temozolomide is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until treatment no longer works or until unacceptable side effects occur.
Click here for the common starting doses.
What are the most common side effects from Bevacizumab +Temozolomide for High-Grade Glioma?
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of bevacizumab + temozolomide are shown here.
Although not reported in the original Bevacizumab + Temozolomide clinical trial, other possible side effects include, but are not limited to, nausea and vomiting, constipation, diarrhea, and mild hair loss.
On average, 8% of patients discontinue treatment due to unacceptable side effects.
Importantly, not all people who experience a side effect from bevacizumab + temozolomide will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with bevacizumab + temozolomide, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
Watch videos on common Bevacizumab + Temozolomide therapy side effects below
How often is monitoring needed?
Labs (blood tests) are usually checked before each treatment cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood pressure, and urine protein level, plus any others your doctor may order.
How often is imaging needed?
Imaging of the site of disease is checked before treatment and is repeated as determined by your doctor. Imaging may include: magnetic resonance imaging (MRI) or computerized tomography (CT) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue bevacizumab + temozolomide as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
What are the most important things to know about bevacizumab + temozolomide while receiving therapy?
- Bevacizumab can impair your body’s ability to heal wounds. Talk to your oncologist about any planned surgeries and let your surgeon know you are taking this drug. Your schedule for surgery or chemotherapy may need to be altered
- Bevacizumab can commonly cause high blood pressure. Consider keeping a blood pressure monitor at home. Your doctor may prescribe a medication to help lower your blood pressure if needed
- Try taking your dose of temozolomide before bedtime on an empty stomach to avoid experiencing nausea and/or vomiting. Make sure you always have medications to help treat nausea with you
- Temozolomide can cause constipation. Drinking water, eating sufficient fiber, and remaining active will help prevent constipation. Over-the-counter medications may also be needed to prevent and/or treat constipation
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for high-grade glioma brain cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Bevacizumab (Avastin®) + Temozolomide (Temodar®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Bevacizumab (Avastin®) + Temozolomide (Temodar®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Bevacizumab (Avastin®) + Temozolomide (Temodar®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Bevacizumab (Avastin®) + Temozolomide (Temodar®)