All about. (bevacizumab) Information for people being treated with Avastin for advanced ovarian cancer

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1 All about (bevacizumab) Information for people being treated with Avastin for advanced ovarian cancer

2 AVASTIN AT A GLANCE Avastin also known as bevacizumab is a medicine used to treat a number of different cancers including advanced ovarian cancer. CONTENTS I. Understanding advanced ovarian cancer and its treatment some background information Avastin is thought to work by disrupting the blood supply to the cancer, restricting the supply of nutrients that the cancer needs to grow and spread. Avastin is usually used with chemotherapy a different type of cancer treatment which aims to kill the cancer cells. Because they work differently, the two types of medicine complement each other when they are used together to treat advanced ovarian cancer. We hope this booklet will answer some of the questions you have, but it does not replace the advice of your doctor and other healthcare professionals. If you have any questions or concerns, make sure you discuss them with your doctor or nurse. You might find it helpful to jot down any questions or concerns you would like to discuss in the back of this booklet and take it with you to your next appointment. Advanced ovarian cancer: the facts Treatments for advanced ovarian cancer About Avastin II. Treatment with Avastin some practical information Your Avastin treatment Before your infusion After your infusion Practical tips for managing side effects III. Other useful resources some places to go for support Getting support Glossary Questions and notes p6 p9 p11 p14 p16 p17 p20 p23 p27 p28 2 3

3 Understanding newly diagnosed advanced ovarian cancer and its treatment Some background information 4 5

4 ADVANCED OVARIAN CANCER: THE FACTS What is ovarian cancer? Cancer occurs when the body s cells grow in an uncontrolled way. Ovarian cancer is cancer that develops from cells of the ovaries, peritoneum or fallopian tubes. This cancer can sometimes spread (a process known as metastasis) when cells break off from the original tumour and are carried in the bloodstream or lymphatic system to other parts of the pelvis, or to areas outside the pelvis (e.g. lungs, liver). The cancer is then called advanced ovarian cancer (or metastatic ovarian cancer). Progression of ovarian cancer Healthy ovaries Ovarian cancer can spread to other parts of the pelvis, or to areas outside the pelvis (e.g. lungs, liver). How common is ovarian cancer? Ovarian cancer is the seventh most common cancer in New Zealand women, with more than 300 New Zealand women diagnosed with it each year. The risk of ovarian cancer increases with age, with the average age of first diagnosis being 63 years. 1 in 78 women will be diagnosed with ovarian cancer before the age of 85. The good news is women with ovarian cancer are now surviving longer than ever before. What causes ovarian cancer? As with many types of cancer, we don t know what causes ovarian cancer. We do know that there are a number of things that can increase your risk of developing it [see box], although it s possible to develop ovarian cancer without having any of these risk factors. Removing the uterus, removing the ovaries and having the fallopian tubes tied, having children and using oral contraceptives are all factors that are thought to help reduce the risk of developing ovarian cancer. Possible risk factors for ovarian cancer Increasing age Family history of ovarian cancer, breast cancer or some other cancers Endometriosis Long-term hormone replacement therapy (HRT) Smoking Obesity Women with ovarian cancer are now surviving longer than ever before. 6 7

5 Symptoms of ovarian cancer The symptoms of ovarian cancer can be similar to many other conditions as they are often vague and non-specific. The most common symptoms of ovarian cancer are shown in the box. Common symptoms of ovarian cancer Abdominal bloating Abdominal or back pain Appetite loss or feeling full quickly Changes in toilet habits Unexplained weight changes General tiredness Indigestion or heartburn TREATMENTS FOR ADVANCED OVARIAN CANCER There are three types of treatment available for newly diagnosed advanced ovarian cancer [see box]. You may already have been given one or more of these. Don t worry if you haven t; your doctor will decide on the appropriate treatment(s) for you based on your own particular case. But if you do have any questions about your treatment, don t be afraid to ask. Surgery Treatments for advanced ovarian cancer Surgery Chemotherapy Biologic therapy Surgery is carried out to try to remove as much of the cancer as possible. The extent of surgery depends on whether the cancer has spread outside the ovaries. If the cancer has spread, it may mean the removal of not only the ovary itself, but also surrounding tissues, including the uterus, fallopian tubes and other ovary. If the bowel is affected, part of it may also be removed. 8 9

6 Chemotherapy Chemotherapy aims to kill cancer cells by interfering with their ability to grow and divide. When you receive chemotherapy, it enters the bloodstream and travels through the body, targeting the original tumour as well as any tumour cells that have spread. Chemotherapy is not very specific; it kills tumour cells, but it also kills normal cells, and that causes many of its side effects. Biologic therapy A biologic medicine is one created by a biological process, rather than a chemical one. Avastin is an example of a type of biologic therapy called a monoclonal antibody. Monoclonal antibodies are designed to specifically recognise and target a particular protein; in this case, a protein called a growth factor, which helps the cancer to grow and spread by initiating the development of its own blood supply. Avastin seeks out and binds to these growth factors, and may interfere with the ability of the cancer to grow and spread. Avastin specifically targets a protein involved in the growth and spread of the cancer. ABOUT AVASTIN How does Avastin work? Avastin is thought to work by disrupting the blood supply to the tumour, restricting the supply of nutrients that it needs to grow and spread. It does this by preventing a process called angiogenesis. Angiogenesis is when new blood vessels develop to support the growth of new tissues, by delivering the nutrients and oxygen they need. In cancer, a new blood supply develops to support the growth of the tumour. VEGF Angiogenesis The body is programmed to grow new blood vessels by the tumour, which does this by releasing substances called growth factors. Avastin works by blocking an important growth factor called vascular endothelial growth factor or VEGF. Vascular relates to blood vessels; endothelial relates to the type of cell in the blood vessel which VEGF acts on to cause the growth of new blood vessels (angiogenesis). Blocking the growth of new blood vessels reduces the ability of the tumour to grow and spread

7 Treatment with Avastin Some practical information 12 13

8 YOUR AVASTIN TREATMENT Starting treatment with Avastin Your doctor will likely start your Avastin treatment with your first or second cycle of chemotherapy depending on how you have recovered from surgery. You may receive 6 cycles of chemotherapy combined with Avastin followed by ongoing Avastin treatment (even after your chemotherapy has stopped). When you start treatment with Avastin, your doctor will perform regular tests to check what effect Avastin is having on the tumour. He or she will rely on you to report how your treatment makes you feel. It s important that you tell your doctor about any side effects you experience while you are being treated. Your Avastin treatment may continue after your chemotherapy is completed and may be given for up to 15 months. The length of treatment depends on: How is Avastin given? Avastin is given as an intravenous (IV) infusion. This means it is slowly pumped into a vein through a cannula (soft needle) inserted in your arm or the back of your hand, or through a catheter, or port, inserted in your chest. You will probably be treated with Avastin every 3 weeks. If you are also receiving chemotherapy, your Avastin will usually be administered following your chemotherapy. The first time you receive treatment with Avastin, the infusion will take about 90 minutes, but subsequent infusions will be faster, generally 30 to 60 minutes. If you would like to know more about how Avastin is given, ask your doctor or chemotherapy nurse. Avastin is usually given every 3 weeks. The effect it is having on the tumour How the treatment makes you feel. Your doctor relies on you to tell him or her how you are feeling

9 BEFORE YOUR INFUSION Prepare for your Avastin infusion using the list below as a guide. Being well prepared will help the day run smoothly for you. These tips will probably be applicable to any chemotherapy you may be receiving at the same time as Avastin, however, you should check with your doctor to see if there are any special requirements for your chemotherapy. 1. Set aside a whole day Your Avastin infusion does not take very long; with the exception of your first infusion, it will probably take less than one hour. However, it takes time for your nurse to set everything up for the infusion, check that you are well enough for treatment, and administer any medication you need before the infusion. And, of course, you may be receiving chemotherapy before your Avastin treatment. After your infusion is finished, the doctor or nurse will want to take some time to check that you are okay to go home. 2. Arrange some help It s important that you do not drive yourself home after your treatment. Ideally, ask a friend or relative to take you to and from the clinic. Otherwise, book a taxi; but be sure someone is waiting for you at home or will call to check up on you at the end of the day. 3. Dress comfortably Wear something comfortable. Layers are good so you don t get too cold or too hot. 4. Bring something to do You will usually have your infusion in the chemotherapy outpatients department. You will have to sit still while the infusion is in progress so bring something to keep you entertained, like a magazine or book. 5. Eat normally Unless your doctor tells you otherwise, you should eat normally before and after your treatment. Check whether there is food available at the clinic; and if not, take some food and something to drink with you. AFTER YOUR INFUSION What happens after my infusion? When your Avastin treatment is finished, and the doctor or nurse has checked you are okay, you can usually go home. You will only need to stay at the clinic if you experience a side effect that your doctor wants to keep an eye on. When you get home You may be quite tired after your Avastin treatment, so don t plan on doing anything very active that evening, or the following day. When you get home, take some time to rest. Your doctor or nurse will tell you anything else you need to know. Possible Side Effects All medicines can have some unwanted side effects. Sometimes they are serious, but most of the time they are not. If you experience any of the side effects in the list below, tell your doctor immediately or go to your nearest Accident and Emergency Centre. These side effects are rare but you may need urgent medical attention. severe body pain including headaches stomach cramps or pains severe diarrhoea, nausea and vomiting coughing or spitting blood deep vein thrombosis (blood clots in the veins of legs) pain and/or swelling in the lower legs, feet or hands severe bleeding or problems with your wounds healing after surgery seizures (fits), confusion sleepiness, drowsiness or fainting abscesses (pus-filled sores) severe infection with high fever, chills, headache, confusion and rapid breathing 16 17

10 feeling of numbness or tingling in hands or feet dry mouth in combination with thirst and/or reduced or darkened urine problems with the heart with breathing difficulties increase in heart rate (pulse) shortness of breath symptoms of an allergic reaction which may include shortness of breath; wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body or rash, itching or hives on the skin Numbers to call Clinic: Emergency after hours: Oncologist: Other: Below is a list of the common side effects of Avastin. These are mainly mild. High blood pressure (your doctor or nurse will monitor your blood pressure) Body pain Lack of energy or tiredness Diarrhoea, constipation or rectal bleeding Inflammation of the mouth Loss of appetite Shortness of breath Nosebleed, runny or blocked nose Dry skin, flaking, swelling or redness of the skin, or change in skin colour Change in sense of taste Eye problems (watery eyes or blurred vision) Dizziness Fever, headache Changes in your voice or hoarseness, difficulty speaking Please do not be alarmed by the list of possible side effects. You may not experience any of them. If you have any concerns about the side effects of Avastin, talk to your doctor or another member of your healthcare team. You may not experience any of these side effects

11 PRACTICAL TIPS FOR MANAGING SIDE EFFECTS It is important that you are prepared for and know how to manage any side effects you may experience with Avastin. Here are some practical tips for recognising and managing the more common side effects. Nosebleeds Avastin may cause nosebleeds. If you experience a nosebleed, apply pressure to the soft part of your nostrils, below the bridge of your nose. Sit with your head tipped forward to avoid blood flowing down your throat. Stay seated for at least 10 minutes. If the bleeding hasn t stopped after 20 minutes, call your doctor. High blood pressure Weakness/fatigue Weakness and fatigue are common symptoms for patients with cancer and can occur in those treated with Avastin. If you do get very tired, it can sometimes be helpful to set priorities, pace yourself, schedule activities for when you have more energy, take naps that do not interrupt night-time sleep and use a structured daily routine. It s a good idea to make a note of any changes in your energy levels to discuss with your doctor or healthcare team. Pain Some patients treated with Avastin have experienced mild discomfort or mild pain. If you are experiencing pain, speak to your doctor who may prescribe medication for you. Tell your doctor if you are being treated for high blood pressure, or have received treatment in the past for this. Your doctor or nurse will check your blood pressure every time you go for your infusion. If you develop high blood pressure while you are being treated with Avastin, your doctor will probably prescribe an anti-hypertensive medication (a medicine which lowers blood pressure)

12 Other useful resources Some places to go for support GETTING SUPPORT You will understandably be experiencing a range of emotions during your cancer treatment, so it is important that you can rely on your family and friends for support if and when you need it. There are also some very good organisations that offer support for people with cancer; they can answer your questions and provide information about looking after yourself properly, as well as providing practical support. It is essential you look after yourself properly throughout your treatment

13 Family and friends With whom you discuss your cancer and its treatment is a very personal decision. If you talk about your cancer with friends and family, you may find you receive a lot of help and understanding from some, but others find it difficult to know what to say or how to act around you. Take your time deciding who you will lean on, but don t make the mistake of thinking you have to make this journey alone. Friends and family may want to help you, but might not know what to do. If a friend asks how they can help, don t be shy about telling them they will probably be pleased to know they are doing something you really need. Some may be great with practical help, such as keeping an eye on the garden, or helping you complete paperwork. There may be others with whom you are more comfortable sharing your fears and concerns. Useful organisations The organisations below provide support and assistance to people living with cancer. New Zealand Gynaecological Cancer Foundation The New Zealand Cancer Society Don t try and do everything on your own; there are people who will want to help

14 GLOSSARY Angiogenesis Chemotherapy Lymphatic system Malignant Monoclonal antibody Primary tumour Vascular endothelial growth factor (VEGF) The process by which new blood vessels develop to support the growth of new tissues (including tumours) by delivering the nutrients and oxygen they need. A cytotoxic (toxic to cells) form of treatment for cancer that kills cancer cells or slows their growth. A network of tiny vessels that collect fluid and waste products from the body s tissues. Another word for cancerous. Malignant cells can spread throughout the body. A group of medications made from different types of proteins that target specific diseased cells, attach to them and destroy them. The original tumour. Cells from the primary tumour may break away and be carried to other parts of the body, where secondary tumours may form. A protein that helps tumours form new blood vessels to get oxygen and nutrients

15 QUESTIONS AND NOTES QUESTIONS AND NOTES If you have any questions about your treatment with Avastin, write them down on these pages. Take this booklet with you next time you see your doctor

16 This booklet is intended as an educational resource for people who have been prescribed Avastin for the treatment of advanced ovarian cancer. It is not intended as a substitute for information from a qualified medical professional, nor is it considered a comprehensive and exhaustive source of information. Avastin (bevacizumab), 100 mg/4ml and 400 mg/16 ml vials, is a Prescription Medicine used to treat metastatic (spreading) colorectal, kidney, breast, brain, lung and ovarian cancers. Do not use Avastin if: you have had an allergic reaction to Avastin, any of its ingredients or other antibodies, or if you have been coughing or spitting up blood. Tell your doctor if: you are pregnant or breast-feeding, or plan to become pregnant or breastfeed; you have any other health problems, especially the following: inflammation of the bowel or stomach ulcers, high blood pressure, a history of blood clots or stroke, bleeding problems, bleeding in the lungs or coughing or spitting up blood, low white blood cell counts, you have/ had a fistula, or have a history of diabetes; you have had major surgery in the last 28 days or a wound that has not healed properly; you have had a blocked lung artery (pulmonary embolism); you have heart disease; you have received anthracyclines (e.g. doxorubicin) for cancer, or radiotherapy to your chest; you are 65 years of age or older, or you are taking any other medicines. Possible unwanted effects include: Common: high blood pressure (symptoms include, headache, dizziness, ringing in the ears, tiredness, blurred vision); body pain, tiredness/ weakness; diarrhoea, constipation or rectal bleeding; sore mouth or mouth ulcers; loss of appetite, being thirsty; shortness of breath; runny, blocked or bleeding nose; dry, scaling or inflamed skin, change in skin colour; taste changes; blurred vision or other eye problems; dizziness; headache; frequent infections with symptoms such as fever, chills or sore throat; changes in your voice or difficulty speaking. Serious (rare): severe body or stomach pain or cramps; headache; severe diarrhoea, nausea and vomiting; coughing or spitting up blood; clots in the veins of the legs; pain and/or swelling in the lower legs, feet or hands; severe bleeding or problems with your wound healing; seizures; confusion; sleepiness/drowsiness or fainting; abcesses (pus-filled sores); severe infection with high fever, chills, headache, confusion and rapid breathing; feeling of numbness or tingling in feet or hands; dry mouth with thirst and/or darkened urine; increased heart rate; shortness of breath; symptoms of an allergic reaction which may include shortness of breath, wheezing or difficulty breathing, swelling of the face, lips, tongue or other parts of the body, or rash, itching or hives on the skin. Ask your oncologist if Avastin is right for you. Use strictly as directed. If symptoms continue or if you experience side effects or would like further information, please talk to your oncologist or pharmacist, or visit for Avastin Consumer Medicine Information. Avastin is not a cure for cancer. Avastin is not funded by PHARMAC. You will need to pay for this medicine. A prescription charge and normal oncologist fees apply. Consumer panel based on CMI dated 05 March 2014 Roche Products (New Zealand) Limited, Auckland. Phone: All trademarks mentioned herein are protected by law. ID1874 / TAPS7175 / 2014JUN

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