a big question about the Avastin dosage ... help me please

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Monimom
Posts: 49
Joined: Wed Jan 08, 2020 6:15 pm

a big question about the Avastin dosage ... help me please

Postby Monimom » Wed Aug 19, 2020 5:55 am

Hi,

I was curious how can I find out if the amounts of meds my DH is receiving is within parameters , first I am curious if he is on palliative / maintenance chemo would the dosing be the same as curative dosing??

also, he recently switched to Xeloda but is still required to receive Avastin every 3 weeks. II just looked at his chart and see that have increased the dosage, do they increase the dosage when you go every 3 weeks ?? isn't that more aggressive? and umm more dangerous??

How can I have his chemo regimen reviewed ? any one here have extensive knowledge in dosing etc.??
this is how it is listed now, (the second line is new)

BEVACIZUMAB PER 10 MG (50242-061-01) - quantity: 40 - J9035 (HCPCS)

BEVACIZUMAB 100 MG/4ML SOLN 4 ML VIAL (50242-060-01) - quantity: 20 - J9035 (HCPCS)

this is how it is listed on his after visit summary... the dosage seems different , no ??

Medications Given
bevacizumab (AVASTIN) injection 25 mg/mL Stopped 8/14/2020 3:54 PM
heparin flush (porcine) Last given 8/14/2020 3:58 PM for Malignant neoplasm of descending colon


I hate to sound paranoid but at this point I think I've lost all faith in his Onc. so maybe im just "looking" for issues. please chime in and smack me around if need be ..lol

Thank you ,
Moni : )
Oct 2019 56 yo Husband DX'd
Stage 4 MCC
Colon thickening w/ apple core 3.9 cm area
Liver mets both lobes 10.4 x 7.6 cm & 9.3 x 7.7cm
innumerable small lesions
Oct 2019 Liver Biopsy
CEA Dec '19 . 3,028
Dec 2019-present 5FU, Avastin & Oxaliplatin
Jan '20. CEA 1861.8
Feb '20 CT mets 9.4cm x 6.5 & 8.0 x 6.7 cm
April '20 CEA 411.1
May '20 CT mets 8.6cm x 6.3 & 5.7 x 6.1 cm
Colon unchanged

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: a big question about the Avastin dosage ... help me please

Postby Rock_Robster » Wed Aug 19, 2020 7:40 am

Firstly, doses are not necessarily different between curative and palliative treatment. They can be, but these terms generally refer to the intent of the treatment, not the protocol itself. Of course palliative patients may choose to go for a lower dose, but this isn’t automatic. The only way to be clear on this is to ask the oncologist (which I would encourage if you want to know!).

Secondly, my standard advice is it’s always best to clarify medication questions with the oncologist or pharmacist (or chemo nurse), but we can say a few things from what you’ve provided.

Avastin dosing is usually different depending on whether it’s given every 2 or 3 weeks. For example, the standard 2-week dose is often 5 mg per kg of body weight, and the 3-week dose is often 7.5 mg per kg of body weight. So in this way the “weekly” dose is the same (ie “2.5 mg per kg per week”), but it’s given at different intervals.

Next, it’s difficult to see an actual dosage in what you’ve shown. What is there is a concentration - the injection he was first given had 25 ml of Avastin in every 1 ml of solution. The second injection had 100 ml of Avastin in every 4 ml of solution; which you’ll notice is actually the same solution strength (ie 1:25).

So to work out his dose, we need to know his weight. At the top it says “bevacizumab 10mg per” and then a quantity of 40 in total. This might suggest 400mg of bev, which is about the right fortnightly dose for an 80kg (175 lb) person.

In the second line it says 4 ml of a solution 100mg/4ml; so 100mg of bevacizumab. It then has a quantity of 20, which is 2000 mg of bevacizumab. I can only assume this isn’t all to be administered at once, and they have ordered for use over time. No-where in this does it actually seem to say how much he is to be given in a single dosage (as I say that would need his weight as an input too). Someone else here may be able to interpret that line better than me however.

The short answer on how to have his regime reviewed is to talk to his oncologist. If you don’t have faith in this oncologist, then it sounds like it’s time for a second opinion.

Best of luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Monimom
Posts: 49
Joined: Wed Jan 08, 2020 6:15 pm

Re: a big question about the Avastin dosage ... help me please

Postby Monimom » Wed Aug 19, 2020 9:17 am

Thank You ,
here is how it is written in detail,

bevacizumab (AVASTIN) 600 mg in sodium chloride (NS) 0.9 % 100 mL IVPB
600 mg (rounded from 564.75 mg = 7.5 mg/kg × 75.3 kg Order-specific weight), Intravenous, Administer over 15 Minutes, Once, Fri 8/14/20 at 1600, For 1 dose

he is 5'7 and 167 lbs. and the infusion is 1x every 3 weeks.


he's on Xeloda along with this, he takes 1800 mg. 2x daily for 14 days ...
all of this seem on par ??


Thank you, and I agree with all of your advice.

Moni : )
Oct 2019 56 yo Husband DX'd
Stage 4 MCC
Colon thickening w/ apple core 3.9 cm area
Liver mets both lobes 10.4 x 7.6 cm & 9.3 x 7.7cm
innumerable small lesions
Oct 2019 Liver Biopsy
CEA Dec '19 . 3,028
Dec 2019-present 5FU, Avastin & Oxaliplatin
Jan '20. CEA 1861.8
Feb '20 CT mets 9.4cm x 6.5 & 8.0 x 6.7 cm
April '20 CEA 411.1
May '20 CT mets 8.6cm x 6.3 & 5.7 x 6.1 cm
Colon unchanged

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: a big question about the Avastin dosage ... help me please

Postby Rock_Robster » Fri Aug 21, 2020 2:40 am

Ok great, so the Avastin dose looks right - he’s getting 7.5 mg per kg of body weight (rounded up to 600 mg), every 3 weeks.

The Xeloda dosing is based on body surface area (BSA), and from his height and weight his BSA is around 1.8 m2. A standard dose is often 1250 mg/m2 twice daily. In his case, this would work out to around 2250 mg twice daily. The dose of 1800 mg twice daily hence seems a bit lower than the norm, but there are lots of very valid reasons to adjust the dose so this is probably a good one to clarify with his oncologist.

Good luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial


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