Treatment Name: Topotecan + Paclitaxel + Bevacizumab (Avastin®)
Topotecan + Paclitaxel + Bevacizumab (Avastin®) is a Chemotherapy Regimen for Cervical Cancer
How does topotecan + paclitaxel + bevacizumab work?
Topotecan and paclitaxel are designed to target rapidly dividing cells-- this kills or slows the growth of cervical cancer cells. Bevacizumab is designed to slow the growth of cancer cells by decreasing the spread of blood vessels carrying nutrients to cancer cells.
Goals of therapy:
Topotecan + paclitaxel + bevacizumab is given to shrink tumors or alleviate symptoms of cervical cancer. It is not commonly given with the goal of cure, but may help patients live longer.
- Bevacizumab intravenous (I.V.) infusion over 90 minutes on Day 1 of Cycle 1
- then over 60 minutes for Day 1 of Cycle 2, if no infusion reactions occur
- then over 30 minutes for Day 1 of Cycles 3 and on, if no infusion reactions occur
- Paclitaxel I.V. infusion over 3 hours on Day 1
- Topotecan I.V. infusion over 30 minutes on Days 1, 2, and 3
Estimated total infusion time for this treatment:
- Up to six hours for Cycle 1, Day 1; up to five hours for Day 1 of subsequent cycles if bevacizumab is well tolerated
- Up to one hour on Days 2 and 3 of each cycle
- 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
Topotecan + paclitaxel + bevacizumab is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick for outpatient treatment.
Topotecan + paclitaxel + bevacizumab is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for common starting doses.
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 topotecan + paclitaxel + bevacizumab side effects are shown here:
Up to 25% of patients discontinue treatment due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and in-between treatments at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), urine protein level, plus any others your doctor may order. Cancer Antigen-125 (CA-125) blood test may be checked every cycle or less frequently to monitor response to therapy.
How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment, which may be as often as before every other treatment cycle. Imaging may include: X-rays, 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 topotecan + paclitaxel + bevacizumab as planned, change doses, or delay or switch therapy.
- Paclitaxel may cause infusion reactions when used as an I.V. formulation. Patients may receive several medications prior to receiving paclitaxel (this is known as "pre-medication") to decrease the risk of infusion reactions. Common pre-medications given are a histamine-2 blockers such as famotidine (Pepcid®) or ranitidine (Zantac®), a histamine-1 blocker such as diphenhydramine (Benadryl®), and a corticosteroid such as dexamethasone
- This chemotherapy regimen can cause tingling and nerve pain in the hands and feet called, neuropathy. Tell your doctor if you are having any pain, especially if it is affecting your ability to complete your daily activities
- 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
- Seek help immediately if you experience severe abdominal pain with fever, nausea, or vomiting or if you are experiencing trouble breathing, severe chest pain, or redness, pain, and swelling in your arms or legs as these can be signs of life threatening condition
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for cervical 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 Topotecan + Paclitaxel + Bevacizumab (Avastin®), 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 Topotecan + Paclitaxel + Bevacizumab (Avastin®). Depending upon your income, they may be able to help cover the cost of:
- Topotecan IV
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 Topotecan + Paclitaxel + Bevacizumab (Avastin®) 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 Topotecan + Paclitaxel + Bevacizumab (Avastin®)