regimen-monograph

PACL(W)+BEVA

Intent

Palliative

Regimen Category

ARCHIVED

Drugs Used

bevacizumab , PACLitaxel

A - Regimen Name

PACL(W)+BEVA Regimen

PACLitaxel (weekly)-Bevacizumab

Disease Site

Breast

Intent

Palliative

Regimen Category

Archived : No longer in use and listed for reference purposes only, although the use of such a regimen may be appropriate in a situation where a Standard Regimen cannot be used for clinical reasons. Note: The Disease Site Group considers this regimen archived. It is listed for historical reference only and is no longer updated.

Rationale and Uses

Note: Health Canada has suspended the authorization of bevacizumab for use in the treatment of metastatic breast cancer (Nov 28, 2011).

For treatment of patients with metastatic HER-2 negative breast cancer who are ECOG Class 0-1. For patients receiving taxane-based chemotherapy as first-line therapy*, the addition of bevacizumab could be offered to improve progression-free survival.
_{*Disease Site Group (DSG) recommendation. The DSG does not recommend the addition of bevacizumab to chemotherapy for patients with metastatic breast cancer receiving second-line therapy or greater.}

B - Drug Regimen

bevacizumab

10 mg /kg

IV *

Days 1 and 15

_{(*Give bevacizumab IV over 90 minutes for initial dose; if tolerated next infusion can be given over 60 minutes; can thereafter be given over 30 minutes as maintenance dose)}

PACLitaxel

90 mg /m²

IV over 1 hour

Days 1, 8, 15

C - Cycle Frequency

REPEAT EVERY 28 DAYS

Until evidence of disease progression or unacceptable toxicity

D - Premedication and Supportive Measures

Antiemetic Regimen:

Low

Other Supportive Care:

Paclitaxel: Patients should be pretreated with a corticosteroid as well as an antihistamine and a H2 blocker: For example:
DEXAMETHASONE 20mg PO 12 & 6 hours or 20mg IV 30 minutes before paclitaxel
DIPHENHYDRAMINE 50mg IV 30 minutes before paclitaxel
RANITIDINE 50mg IV 30 minutes before paclitaxel

E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
See Appendix 6 for general recommendations.

Dosage with toxicity

Toxicity / Counts x 10⁹/L			Paclitaxel		Bevacizumab
Toxicity / Counts x 10⁹/L			Day 1, 8 or 15	If recurs or ≥ 3 weeks
AGC > 1.5	And	Platelet > 100	No change	-	No change
AGC 1-1.5	Or	Platelet 75-100	↓ to 65mg/m²; ↑ to 90mg/m² when recovers	-	No change
AGC < 1	Or	Platelets < 75	Hold then treat as above	-	No change
AGC ≥ Grade 3 ≥ 7 days or Febrile neutropenia	Or	Platelets ≤ 20 OR ≤ 40 with bleeding	Hold then permanently ↓ to 65mg/m²when recovers	-	No change
Neuropathy ≥ Grade 3			Hold until ≤ Grade 1, Then ↓ to 65mg/m²	Discontinue	No change
Severe HSR			Discontinue	-	Discontinue
Uncontrolled HTN, surgery	Or	Grade 3 proteinuria	Consider Hold	-	Hold
Cardiac failure, RPLS, fistula, perforation, thromboembolism	Or	≥Grade 3 bleeding, Grade 4 HTN, proteinuria	Consider Hold and ↓ to 65mg/m²	-	Discontinue

Hepatic Impairment

Bilirubin		AST	Paclitaxel	Bevacizumab
2-4 x ULN	OR	5 -10 x ULN	REDUCE to 65mg/m²	No change
> 4 x ULN	OR	> 10 x ULN	REDUCE further or OMIT	No change

F - Adverse Effects

Refer to bevacizumab, PACLitaxel drug monograph(s) for additional details of adverse effects

G - Interactions

Refer to bevacizumab, PACLitaxel drug monograph(s) for additional details

H - Drug Administration and Special Precautions

Refer to bevacizumab, PACLitaxel drug monograph(s) for additional details

I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

Clinical toxicity assessment (including hypersensitivity, bleeding, perforation, fistula, fatigue, peripheral neuropathy, musculoskeletal, gastrointestinal).
Baseline and regular liver and renal function tests
Baseline and regular CBCs
Monitor blood pressure during paclitaxel infusion and every 2-3 weeks during bevacizumab therapy and more frequently in pts who develop hypertension.
Baseline and regular dipstick urinalysis; 24 hour urine collection is recommended for patients with a 2+ or greater urine dipstick
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

J - Administrative Information

Approximate Patient Visit

Paclitaxel only: 2 hours; Paclitaxel with Bevacizumab: 2.5 to 3.5 hours

Pharmacy Workload (average time per visit)

21.92 minutes

Nursing Workload (average time per visit)

44.83 minutes

K - References

Miller K, Wang M, Gralow J, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 2007; 357: 2666-76.

CCO-CED Special Advice Report: The Use of Bevacizumab in Metastatic Breast Cancer

L - Other Notes

^{_{December 2011: Modified section A}}

M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
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Last Updated: July 21, 2026

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