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Avastin (bevacizumab) for advanced cervical cancer

Bevacizumab is a targeted drug treatment for advanced cervical cancer. It aims to help control the cancer and any symptoms. It is also known as the brand name Avastin. 

We know that being diagnosed with advanced cervical cancer can be overwhelming – we are here to support you and help make sense of things. We have a lot of support services that you might find helpful, including a free Helpline on 0808 802 8000

Get support > 

On this page:

What is Avastin (bevacizumab)?

Avastin is called a targeted drug. This is because it targets a part of the cancer cell called vascular endothelial growth factor (VEGF). VEGF helps cells make blood vessels, which they need to grow. By targeting this part of the cancer cell, Avastin makes sure the cancer can’t grow.    

Bevacizumab needs to be given alongside chemotherapy for it to control cervical cancer. You will normally have it with a combination of chemotherapy drugs:

  • paclitaxel and cisplatin or carboplatin
  • paclitaxel and topotecan

Read about chemotherapy for cervical cancer > 

Who can have Avastin (bevacizumab)?

You may be able to have Avastin if you have:

  • cancer that has spread to other parts of the body (metastatic)
  • cancer that has come back after other treatments (recurrent). 

You need to have Avastin with chemotherapy, so your healthcare team will check you are well enough to cope with any side effects of these treatments.    

Availability of Avastin

In the UK, Avastin is only available in some countries and in certain situations.

If you live in England, your cancer doctor will need to apply to the Cancer Drugs Fund (CDF) so you can have Avastin. This is called making an individual funding request. 

In England, Avastin is only used to treat metastatic cervical cancer – where it has spread to other parts of the body.

If you live in Scotland or Northern Ireland, Avastin is only available for restricted use. This means it can be used to treat metastatic or recurrent cervical cancer, and has to be used in combination with chemotherapy.

Avastin is not available in Wales.

If Avastin is not available for you

If Avastin is not available, you can talk to your healthcare team about what to do next. Macmillan Cancer Support provide more detailed information and support about this.

Read more on Macmillan Cancer Support’s website >

Making decisions about treatment

A team of healthcare professionals, called a multidisciplinary team or MDT, will discuss your test results, diagnosis and medical history to help decide which treatments are best for you.

It is important that you are involved in any decisions about your treatment. You need to know and understand all the information about the treatment, including the benefits and risks. 

Read about making treatment decisions >

Before Avastin (bevacizumab) treatment

Avastin is given in cycles. A cycle is when you have the Avastin and chemotherapy drugs and then have a rest to let your body recover.

You usually have Avastin every 2 to 3 weeks. Your treatment may carry on for 3 to 6 cycles, if your healthcare team can see the treatment is helping. Ask your healthcare team to talk through your exact treatment plan, as it will be tailored to you. 

You will usually have chemotherapy followed by Avastin at the same appointment. 

At your appointment, you will usually have 3 doses of Avastin: 

  • First dose: Takes 90 minutes. If you don’t have any reactions to it, you can have the next dose.
  • Second dose: Takes 60 minutes. If you don’t have any reactions to it, you can have the next dose.
  • Third dose: Takes 30 minutes. Every dose after that takes 30 minutes.

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. Your healthcare team will also check your:

  • blood pressure 
  • wee – to see how well your liver and kidneys are working.

You will normally have Avastin as an outpatient. This means you don’t have to stay in hospital overnight. 

Treatment can take at least 3 hours. You usually have to sit still in chair, so it can help to bring some things with you, such as:

  • books or magazines
  • a phone or device to listen to a podcast or music 
  • an activity like knitting or a mindfulness colouring book. 

Your hospital may not have good WiFi, or you may be asked to turn off your phone signal and connection (aeroplane mode), so it can help to download any music or films before your appointment.

During Avastin (bevacizumab) treatment

You will usually have Avastin through a drip into your arm. You might feel a small sting and some discomfort as your nurse puts the needle and a thin tube (cannula) into your vein. They will take the needle out and the Avastin travels from a drip bag into your bloodstream. 

Sometimes you may have treatment through a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. 

Read about central lines on the Cancer Research UK website >

After Avastin (bevacizumab) treatment

As long as you are well enough, you should be able to go straight home after each treatment.

Recovering from Avastin 

It can take some time to recover and feel like yourself again after treatment. The exact time will depend on:

  • the side effects you have
  • your general health. 

Generally, it takes a few months to recover from treatment with Avastin. But you may have long-term effects that can last for years. 

You will need to rest to help your recovery. Try to limit your normal activities until you start feeling better, as these can take a lot of energy. Remember to be kind and gentle to yourself – recovery takes time and you may also be recovering from surgery or chemoradiation too. 

If you are struggling with your emotions before, during or after Avastin, you are not alone. We know that lots of women and people who have had a cervical cancer diagnosis or treatment feel sad, down or depressed. Sometimes this can last a long time after treatment has finished.  

Read about mental health and cervical cancer > 

Check-ups after Avastin

After Avastin treatment has finished, your healthcare team will want to make sure you continue to get the proper treatment and support.

Once your treatment is finished, you should be given a treatment summary. This is a document by your healthcare team that explains:

  • what treatments you have had
  • any side effects you might have
  • signs and symptoms to look out for 
  • a plan that has been made for your long-term care and support.   

This treatment summary should also be sent to your GP surgery, so they know how to support you too. You might want to check that the hospital have sent it to them.

You will also have check-ups with your healthcare team. You might see or speak to your consultant oncologist, clinical oncologist, or clinical nurse specialist (CNS). 

There is no standard follow-up for advanced cervical cancer. Your healthcare team will talk to you about the plan for your individual situation, so they can give you the best care possible.

The check-up appointments you have will:

  • check whether the treatment has controlled the cancer
  • monitor any side effects 
  • provide you with support.

These check-ups may be at the hospital, or by phone or video call. The COVID-19 pandemic means it is more likely you will be offered a phone or video call check-up, as your healthcare team will be following safety rules put in place by the hospital. However, if you or your healthcare team would prefer that you go into the hospital, they will arrange this for you.  

You may need to go into the hospital to have scans. These scans will check whether the cancer has been controlled or spread further. The results can help you and your healthcare team decide whether to continue with the treatment. 

You may also have physical examinations during your check-ups. These may include:

  • a pelvic examination – where your healthcare professional feels your stomach and may put gloved fingers inside your vagina 
  • a speculum or visual examination – where your healthcare professional uses a speculum (plastic tube) to gently open your vagina and look at your vagina or cervix, if you still have one.

Avastin is designed to prolong life by controlling advanced cervical cancer, rather than treating it. 

Research suggests that Avastin can add about 4 months to life expectancy in patients with advanced cervical cancer. This does not mean that a patient would definitely die 4 months after treatment with Avastin. It means that about 4 months may be added to their current prognosis (how long they are expected to live).

We know that thinking about survival can be distressing, which is why we are here to support you. If you want to understand more about prognosis, connect with others in a similar situation, or simply talk with someone about what’s going on, we have a service to fit your needs.

Get support > 

Risks and side effects of Avastin (bevacizumab)       

Avastin may cause side effects. These may only last while you have the treatment or may last for weeks, months or years after treatment has finished. It is important to remember that not everyone gets all possible side effects and there are ways to manage any side effects you do get. 

Common side effects of Avastin

These side effects happen in over 10 in 100 (over 10%) people who have Avastin.

It’s important to look out for signs of an infection while you are having Avastin. Your immune system will be weak, so even mild infections can be become very serious if you don’t get treatment. You should contact your healthcare team if:

  • you feel generally unwell
  • you have any new symptoms 
  • your temperature is 37.5ºC or above 
  • your temperature is below 36 ºC. 

Avastin can cause high blood pressure. If you already have high blood pressure, you should let your healthcare team know before starting treatment. They can give you treatment to control it.

This treatment can cause:

  • loose or runny poo (diarrhoea) 
  • problems doing a poo (constipation).

These bowel changes can start to happen about a week after having treatment. 

It is important to let your healthcare team know about any bowel changes, as they may be able to prescribe medicines and suggest things to help. You may find it helpful to eat smaller meals more often and take sips of water throughout the day.

This treatment can make you feel very tired and physically weak. This is called fatigue. It is not like usual tiredness – you may feel exhausted after doing nothing. This is simply your body responding to the treatment, as it tries to repair any healthy cells the chemotherapy has damaged. 

Fatigue may only last for a few days or weeks after treatment, but it can last for months. Speak with your healthcare team if you feel fatigued, as they may be able suggest things to help. Tips from our community include:

  • getting moving – gentle exercise like a walk or yoga can help
  • getting some fresh air – even if it’s sitting by an open window.

You may also feel weak because chemotherapy lowers the amount of red blood cells you have. These are the cells that carry oxygen around your body. If you have too few red blood cells, you may develop anaemia. 

The drugs used in this treatment will be new to your body, so it might try to get rid of the drugs by making you want to be sick. This feeling usually happens between within a few hours and 24 hours of starting treatment. It usually lasts for about a week and may come back whenever you have a cycle. You may actually be sick (vomit) too.   

Tell your healthcare team if you feel or are sick with this treatment. They can prescribe you anti-sickness medicine and suggest other ways to help. Tips from our community include:

  • drinking water or ginger tea
  • eating whatever helps the sickness – but check with your healthcare team first
  • practicing mindfulness to focus your thoughts somewhere else.

This treatment can make you feel like you don’t want to eat or have no taste for food. This may be because you feel sick, your taste has changed, or the effects of treatment have simply made you lose your appetite. 

It is important to keep eating and drinking while you are having this treatment. Try to figure out which foods you can eat or want to eat. It’s a good idea to let your healthcare team know too, so they can make suggestions and make sure you are getting enough nutrients.

This treatment can lower the number of platelets in your blood. Platelets help the blood to clot – for example, if you cut yourself. This means you may have bleeding such as:

  • nose bleeds
  • from the gums after brushing your teeth.

You may also notice tiny red or brown spots on your arms and legs. These are caused by blood vessels under the skin bleeding. 

Tell your healthcare team if you are having problems with bleeding. They can assess the problem and offer any support.  

This treatment can cause nerve damage in your:

  • hands
  • feet
  • legs 
  • arms.

This damage that causes pain, numbness and tingling – a bit like pins and needles. This is called peripheral neuropathy.   

Tell your healthcare team if you have symptoms of peripheral neuropathy, as they may be able to suggest treatment or ways to manage it.

This treatment can make things taste different. This may put you off certain foods or make you not want to eat, but it is important to get the right nutrition during treatment. Tell your healthcare team if you have changes to your taste so they can offer suggestions and support.  Less commonly, you may:

  • have sore and swollen mouth and lips
  • find it difficult or painful to swallow 
  • have a hoarse or strained voice.

This treatment can cause changes to your skin, including dry, sore skin on palms of your hands and soles of your feet. These changes usually go back to normal after treatment finishes. 

Ask your healthcare team which products you can use to help with these changes. They should be able to recommend a moisturiser.

This treatment can cause your eyes to water a lot. If this is becoming a problem for you, tell your healthcare team. They should be able to prescribe medication to help. You should also try to avoid anything that could make the watering worse, including pollen or animal hairs.

This treatment can cause your nose to run more than usual. You may want to have a pack of tissues with you during and after treatment.

This treatment can cause pain in your stomach. Less commonly, you may also have:

  • muscle and joint pain or weakness
  • pain headaches 
  • pain in your back, pelvis or near your back passage (rectum)

Let your healthcare team know if you have any pain, as they may be able to prescribe medications to help.

Less common side effects of Avastin

These side effects happen in between 1 and 10 in 100 (1% to 10%) people who have Avastin.

During and after treatment, your healthcare team will monitor you closely for an allergic reaction to Avastin. This happens in 1 to 10 (1% to 10%) people out of 100.  

Signs of an allergic reaction include: 

  • a sudden itchy rash (hives)
  • swelling of your hands, feet, ankles, face, lips, mouth or throat 
  • feeling faint  
  • severe chest pains.  

This sounds worrying, but if it happens your healthcare team can treat you straight away. Let them know if you are having any of these symptoms.

This treatment can cause parts of the inside of the body to become swollen, red and sore, including:

  • the moist lining of mouth and gut
  • lungs and air passages
  • the reproductive tracts
  • the urinary tracts.

Symptoms can include some of effects we have talked about above, including bowel or bladder changes, fatigue and pain. When you tell your healthcare team about these symptoms, they can assess whether it may be caused by inflammation. They should be able to treat it.

This treatment can cause your heart to beat faster than usual. It can be worrying when this happens, so let your healthcare team know. They will be able to assess you and offer support.

Serious complications happen in between 1 to 10 in 100 (1% to 10%) people. These side effects sound alarming, but it’s important to be aware of them. Your healthcare team will monitor you and tell you what signs and symptoms to look out for. They will give you some tests and look at your medical history to make sure you are not at greater risk of these side effects:   

  • Blood clots in your artery or deep vein thrombosis (DVT), which can be life threatening. Signs of a blood clot include pain, swelling, redness and breathlessness. Get in touch with healthcare team or call 999 if you have these symptoms.
  • Damage to your gut or bowel, such as a blockage or hole.
  • An abnormal opening (fistula) between internal organs and skin or other tissues that are not usually connected.
  • Increased risk of infection, including risk of serious infections such as sepsis.
  • Internal bleeding.
  • Heart failure and heart attack.
  • Stroke.

Read about Avastin complications on the Cancer Research UK website >

More information and support

If Avastin has been suggested for you, or you think it should be an option, it is best to talk with your healthcare team. They can answer questions with your medical history in mind and explain any risks, as well as how the treatment might benefit you. 

We are here for you through all of this. Our Helpline volunteers can listen to what’s going on and talk through how you’re feeling. You can give them a call on 0808 802 8000

Check our Helpline opening hours >

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. We have a private forum for those with advanced cervical cancer. If you would like to join, we ask for a few details – this is kept private, but means we can make sure this part of the forum is a safe space. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

If you have general questions about advanced cervical cancer, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.

References

  • Electronic Medicines Compendium (Updated 2020). Avastin 25mg/ml concentrate for solution for infusion. Web: www.medicines.org.uk/emc/product/3885/smpc. Accessed October 2020.
  • Raouf, S. et al (2019). Real-world use of bevacizumab in metastatic colorectal, metastatic breast, advanced ovarian and cervical cancer: a systematic literature review. Future Oncology. 15;5. pp.543-561.
  • Marth, C, et al (2017). Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 28;s4. pp.iv72-iv83
  • Rosen, VM. et al (2017). Systematic Review and Network Meta-Analysis of Bevacizumab Plus First-Line Topotecan-Paclitaxel or Cisplatin-Paclitaxel Versus Non-Bevacizumab-Containing Therapies in Persistent, Recurrent, or Metastatic Cervical Cancer. International Journal of Gynecological Cancer. 27;6. pp.1237-1246.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]

Read more about how we research and write our information >

Pelvic exenteration >

Read about pelvic exenteration surgery for cervical cancer.

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Date last updated: 
04 Nov 2020
Date due for review: 
01 Nov 2023
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