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  • Trastuzumab

    What is Trastuzumab?

    Trastuzumab (pronounced tras-TOO-zoo-mab) is a medication used to treat specific type of breast cancer.

    It is a Y-shaped complex protein, that belongs to the wide group of medicines called therapeutic monoclonal antibodies. Unlike traditional chemotherapy, which directly attacks and destroys rapidly dividing cells of a tumor, trastuzumab attaches selectively to HER-2 receptors on the surface of breast cancer cells.

    Trastuzumab binds HER-2 receptor
    Trastuzumab binds HER-2 receptor on the surface of the immune cells

    What is HER-2 receptor

    Breast cancers that express HER-2 on their surfaces tend to be more agressive. They are much likely to spread to other organs and tissues, inflitrate lymph node, and eventually take over the body.

    By having high affinity to HER-2 receptor, trastuzumab helps immune system to identify and destroy these “agressive” tumor cells, without harming normal tissues and organs.

    Other Drugs with Trastuzumab

    This selectivity attracted scientist, who developed more complex medicines, where trastuzumab fused with chemotherapeutic agents:

    • trastuzumab deruxtecan (Enhertu);
    • trastuzumab emtansine (Kadcyla).

    Scientists call these joint molecules “antibody-drug conjugates”, they are a separate drugs and should not be confused with a trastuzumab.

    What is it Used For?

    Cancer doctors (oncologists) prescribe Trastuzumab specifically to treat breast cancer with HER-2 positive cells. If breast cancer tests negative for HER2, trastuzumab will not provide any benefit.

    To identify the HER-2 status, the tumor tissues extracted during operation or biopsy are sent to lab to measure amount of HER2 protein on the cancer cells. Lab would provide a semiquantative result ranging from 0 to +3:

    • 0 or 1+ means the cancer is HER2 negative;
    • 3+ means the cancer is HER2 positive;
    • 2+ requires further testing (using methods like FISH or CISH) to definitively determine if the cancer is HER2 positive, HER2 negative, or potentially “HER2 low” (a category for which trastuzumab’s benefit is still being researched, often within clinical trials).

    Now, let’s go through particular cases, where trastuzumab proved to be effective.

    Primary Breast Cancer

    This refers to breast cancer that has not spread beyond the breast tissue or the nearby lymph nodes under the arm.

    There are two scenarios, where onclogist gives Trastuzumab:

    • Before Surgery (Neo-adjuvant Therapy). Sometimes, trastuzumab is given before surgery, usually alongside chemotherapy and often with another targeted drug, pertuzumab. The goals might be to shrink a large tumor to make surgery easier, slow down cancer growth, or reduce the chance of the cancer spreading before it can be removed;
    • After Surgery (Adjuvant Therapy). More commonly, trastuzumab is given after surgery (and often with or after chemotherapy, sometimes with pertuzumab) to reduce the risk of the breast cancer coming back (recurring) or spreading to other parts of the body.
      If you received trastuzumab before surgery, it’s typically continued afterwards to complete a standard duration of treatment.

    Breast Cancer That Has Come Back or Spread

    Trastuzumab is also a key treatment for HER2 positive breast cancer that has returned after initial treatment or has spread to other parts of the body (metastatic).

    Doctors like to prescribe it for these three cases of metastatic or reccerent cancer:

    • Local Recurrence. Tumor that comes back in the same breast, chest wall area, or nearby skin after initial treatment;
    • Locally Advanced Breast Cancer. Cancer that has spread to tissues near the breast, such as lymph nodes around the chest, neck, or under the breastbone, especially when surgery isn’t possible;
    • Secondary (Metastatic) Breast Cancer. Cancer that has spread from the breast to distant parts of the body, such as the bones, lungs, liver, or brain;

    How is Trastuzumab Given?

    Trastuzumab can be administered in two main ways:

    • Intravenous Infusion (IV Drip). Your doctor might choose IV infusion based on several factors:
      • Your treatment already contains other IV drugs;
      • You had your cannula installed already for diagnostic and therapeutic purposes;
      • Your condition requires you to stay in the hospital.
    • Subcutaneous (under skin) Injection. More common outpatient option – when you visit your medical team in clinic to receive trastuzumab and go home.
      Health specialist gives it just under your skin, usually in the tight. rotating left and right is common technique would give your skin enough time to heel.

    The most common schedule for trastuzumab is one dose every 3 weeks. For metastatic breast cancer, your doctor might prescribe a once a week injection.

    Intravenous (IV) Administration Details:

    • The very first infusion, often called a “loading dose,” is given more slowly, usually over about 90 minutes;
    • You may be asked to stay at the hospital for several hours after this first dose for observation, to ensure you don’t have an infusion reaction;
    • If the first dose is well-tolerated, subsequent infusions can usually be given more quickly, often over 30 minutes, and the observation time afterwards may be shorter;

    Subcutaneous Injection Details:

    • The injection itself is quick, typically taking between 2 to 5 minutes;
    • Similar to the IV route, you might be asked to stay for observation for a few hours after the very first injection;
    • If there are no problems, you likely won’t need to stay as long after future injections;
    • If you were previously receiving trastuzumab intravenously, your team might suggest switching to the subcutaneous injection form;
    • It’s important to note that biosimilar versions of trastuzumab are generally not available as subcutaneous injections;

    Combination Treatment (Phesgo):

    • If you are receiving both trastuzumab and pertuzumab, these may be combined into a single subcutaneous injection called Phesgo; This is given similarly to the trastuzumab-only injection but contains both drugs; Your treatment team will discuss if this is a suitable option for you, as separate IV infusions might still be recommended for some individuals;

    Duration of Treatment:

    • Primary Breast Cancer (Adjuvant Therapy). Treatment after surgery is usually given for a total of 1 year (approximately 18 cycles); Sometimes, a 6-month duration might be offered;
    • Primary Breast Cancer (Neo-adjuvant Therapy). Treatment before surgery typically involves 4 to 6 cycles; Treatment may then continue after surgery for up to a year in total; In some cases, after surgery, treatment might be switched to a different drug like trastuzumab emtansine (Kadcyla);
    • Secondary (Metastatic) Breast Cancer. Trastuzumab is usually given for as long as it is effectively controlling the cancer and side effects are manageable;

    Missed Doses:
    If you are receiving treatment over many months, you might need to miss or delay a dose (e.g., for a holiday); If a dose is delayed by more than 7 days, you might need another “loading dose” (the initial, larger dose); Always discuss any planned delays with your treatment team beforehand;

    How Does it Work?

    HER2 positive breast cancer cells have an excessive number of HER2 proteins on their surface; These proteins act like antennas, receiving signals that tell the cancer cell to grow and divide uncontrollably;

    Trastuzumab is a monoclonal antibody – a laboratory-made protein designed to recognize and specifically bind to the HER2 protein; When trastuzumab attaches to the HER2 proteins on the cancer cell surface, it does a couple of important things:

    1. Blocks Growth Signals: It prevents the HER2 protein from receiving or sending the signals that stimulate cell growth and division; This effectively “turns off” one of the key drivers of the cancer’s growth;
    2. Flags Cells for Immune Attack: By attaching to the cancer cell, trastuzumab can also act like a flag, signaling to the body’s own immune system cells that this is a cell to be destroyed; This process is called antibody-dependent cell-mediated cytotoxicity (ADCC);

    By interfering with HER2 signaling and potentially activating an immune response, trastuzumab helps to slow down or stop the growth and spread of HER2 positive breast cancer;

    Side Effects of Trastuzumab

    Like all medications, trastuzumab can cause side effects; However, everyone reacts differently, and you may experience some side effects more than others, or possibly none at all; Many side effects can be managed effectively; Since trastuzumab is often given alongside other treatments like chemotherapy or pertuzumab, it can sometimes be challenging to pinpoint which drug is causing a specific side effect; Always report any side effects you experience to your treatment team, regardless of whether they are listed here;

    Common Side Effects

    These are effects that are frequently reported by people receiving trastuzumab:

    • Flu-like Symptoms: Fever, chills, and mild aches or pains can occur, especially during or shortly after the first infusion; These are usually temporary and can often be managed with simple pain relief like paracetamol;
    • Extreme Tiredness (Fatigue): This is a very common side effect, described as exhaustion not relieved by rest; It can affect you physically and emotionally and may persist for weeks or months after treatment finishes; Occasionally, it can be a long-term issue; Fatigue can also be linked to other conditions like anaemia (low red blood cells), so it’s important to let your team know if you experience significant tiredness;
    • Difficulty Sleeping (Insomnia): Simple measures like reducing caffeine, maintaining a regular sleep schedule, and keeping your bedroom dark and quiet may help; Relaxation techniques can also be beneficial; If sleep problems persist, speak to your doctor;
    • Pain in Joints and Muscles: This is often mild and temporary, lasting a few days after treatment, but can sometimes be more severe or persistent; Mild pain relief (like paracetamol or ibuprofen) may help, but discuss the appropriate use, dose, and potential risks (especially if you have stomach ulcers or asthma) with your doctor before taking anti-inflammatory drugs;
    • Nausea and Vomiting: These are usually mild and short-lived with trastuzumab alone, but may be more pronounced if given with chemotherapy; Anti-sickness medications can be prescribed if needed; Eating small, regular meals and staying hydrated can help;
    • Diarrhoea and Constipation: If you have diarrhoea, ensure you drink plenty of fluids; Your doctor can prescribe medication to help; Contact your team if you have 4 or more episodes in 24 hours; For constipation, staying active and eating a high-fibre diet can help;
    • Soreness at the Injection Site: If you receive trastuzumab as a subcutaneous injection, you might experience some temporary soreness, redness, or swelling where the injection was given;

    Effects on Blood Cells

    When given with chemotherapy, trastuzumab can contribute to temporary decreases in blood cell counts; You will have regular blood tests to monitor this:

    • Risk of Infection: Low levels of white blood cells (neutropenia) increase your susceptibility to infections; Your team will give you guidelines, but generally, contact your hospital immediately if you develop a high temperature (e.g., over 37.5°C or as advised), a low temperature (e.g., under 36°C), suddenly feel unwell (even with a normal temperature), or have specific infection symptoms (sore throat, cough, frequent urination, chills/shivering); You may need antibiotics; Keep your 24-hour contact number handy;
    • Anaemia: Having too few red blood cells causes anaemia; Let your team know if you feel unusually tired, breathless, or dizzy;
    • Bruising and Bleeding: Chemotherapy combined with trastuzumab can lower platelet counts (cells that help blood clot); This may lead to easier bruising, nosebleeds, or bleeding gums when brushing teeth; Report any unusual bleeding to your team;

    Allergic or Infusion Reactions

    Some individuals experience a reaction during the infusion/injection or within a few hours afterwards (occasionally later); While severe reactions are uncommon, it’s important to be aware of potential symptoms:

    • Symptoms: May include fever (high temperature), flushing of the skin, feeling faint or dizzy, feeling cold or shivering, shortness of breath, wheezing, back pain, or an itchy rash;
    • Management: You will be monitored closely during and after treatment, especially the first dose, so that any reaction can be managed immediately with medications if necessary; Tell your nurse straight away if you feel unwell during the infusion;

    Heart Problems

    Trastuzumab carries a small risk of affecting the heart muscle, potentially weakening its pumping action or causing an abnormal heart rhythm;

    • Risk Factors: The risk is slightly higher if trastuzumab is given concurrently with certain types of chemotherapy (like anthracyclines), or if you have a pre-existing heart condition or uncontrolled high blood pressure;
    • Monitoring: You will have heart function tests (like an echocardiogram [echo] or a MUGA scan) before starting treatment and regularly throughout (e.g., every 3 months) and possibly for up to 2 years after finishing treatment;
    • Symptoms: Tell your treatment team immediately if you feel breathless (especially when lying down or on exertion), feel like your heart is racing or pounding, or feel dizzy or lightheaded;
    • Management: If heart problems develop, trastuzumab treatment might be paused or stopped permanently; You may need medication to treat the heart problem; Fortunately, heart issues related to trastuzumab often improve once the treatment is stopped;

    Other Common Side Effects

    After the first treatment, other common, usually mild side effects might include:

    • Headaches;
    • Dizziness;
    • Skin rash;
    • Breathlessness (report if new or worsening, see Heart Problems/Lung Problems);
    • Sore eyes (may be red or watery);
    • Dry mouth;

    These often lessen or do not occur with subsequent treatments;

    Before Taking Trastuzumab

    Before you start treatment with trastuzumab, it’s very important to discuss your overall health and medical history with your doctor or specialist nurse; Make sure you tell them if you:

    • Have any heart problems (like angina, previous heart attack, heart failure, valve problems, or irregular heartbeat);
    • Have high blood pressure (hypertension), especially if it’s not well controlled with medication;
    • Have any lung or breathing problems;
    • Are pregnant, think you might be pregnant, or are planning to become pregnant (see below);
    • Are breastfeeding (see below);
    • Have any allergies to medications;
    • Are taking any other medicines, including prescription drugs, over-the-counter medicines, vitamins, herbal supplements, or alternative therapies;

    Your team will usually perform an echocardiogram (echo) or similar test to check your heart function before you begin trastuzumab; If you have existing heart issues, you might be referred to a heart specialist (cardiologist) for further assessment;

    What Should I Avoid While Receiving Trastuzumab?

    • Pregnancy. Trastuzumab can be harmful to a developing baby; It is crucial to avoid becoming pregnant while receiving this treatment and for 7 months after your last dose; Effective non-hormonal contraception (like condoms, Femidoms, diaphragm, or possibly a non-hormonal IUD/coil – discuss suitable options with your team) should be used during this time, even if your periods have stopped; If you think you might have become pregnant, stop trastuzumab immediately and inform your specialist;
    • Breastfeeding. Breastfeeding is not recommended while receiving trastuzumab and for 7 months after treatment finishes, as the drug could potentially pass into breast milk and affect the baby;
    • Vaccinations. Depending on whether you are receiving trastuzumab alongside or after chemotherapy, your ability to receive certain vaccines (like live vaccines for travel, or potentially flu or Covid-19 vaccines) might be affected; Always discuss any planned vaccinations with your treatment team first;

    Brand Names

    Trastuzumab is the generic name of the drug. You might know it by its original brand name or one of its biosimilar versions:

    • Original Brand Name: Herceptin®;
    • Biosimilars: Herzuma®, Kanjinti®, Ontruzant®, Zercepac®, Trazimera®, Ogivri®;
      • (Note: Biosimilars are highly similar versions of the original biological drug, rigorously tested for quality, safety, and effectiveness. They work in the same way but are often less expensive. Your hospital may use a specific biosimilar version.)
    • Combination Brand Name (with pertuzumab): Phesgo® (subcutaneous injection);

    Similar Medications

    Trastuzumab belongs to a class of drugs targeting the HER2 protein; Other drugs used in HER2 positive breast cancer include:

    • Other HER2 Antibodies: Pertuzumab (Perjeta®) – Often used in combination with trastuzumab;
    • Antibody-Drug Conjugates (ADCs): These link an antibody (like trastuzumab) to a chemotherapy drug, delivering the chemo directly to the cancer cells:
      • Trastuzumab emtansine (Kadcyla® or T-DM1);
      • Trastuzumab deruxtecan (Enhertu®);
    • Tyrosine Kinase Inhibitors (TKIs): Small molecule drugs that block HER2 signals from inside the cell:
      • Lapatinib (Tyverb® / Tykerb®);
      • Neratinib (Nerlynx®);
      • Tucatinib (Tukysa®);

  • Pembrolizumab

    What is Pembrolizumab?

    Pembrolizumab (pronounced pem-broe-LIZ-oo-mab) is an anticancer medication that helps immune system to fight tumors.

    Unlike conventional chemotherapy, which directly destroys cancer, pembrolizumab helps immune T-cells to identify tumor cells and let immune system do the job of killing the malignancy. So it is more of an “enhancer” or “enabler” of the immune system, then traditional chemotherapeutic agent.

    Pemrolizumab
    Permbrolizumab works with immune cells raither than targting cancer cells directly

    Pembrolizumab belongs to the class of PD-1 inhibitors within a broader group called immunotherapy – medications that interact with your immune system to treat various diseases and disorders.

    What Pembrolizumab is Used For

    Whether pembrolizumab would be effective depends on a type of the cancers. Your cancer specialist (oncologist) will conduct necessary tests to ensure pembrolizumab is the right choice for your situation.

    Below are the cancer types for which pembrolizumab may be indicated.

    Melanoma (skin cancer)

    Doctors usually precribe it for melanoma that cannot be surgically removed or has spread to other parts of the body (metastatic melanoma).

    Oncologist might try it after surgery for certain stages of melanoma (Stage IIB, IIC, or III) to prevent relapse (when cancer returns).

    Non-Small Cell Lung Cancer

    Pertulizumab is usefull for the specific type of lung cancer called non-small cell lung cancer. Doctors might prescribe it as a standalone cancer treatment, but usually it goes along with other anti-cancer drugs.

    Head and Neck Squamous Cell Carcinoma

    Can be an initial treatment for head and neck cancer (HNC) at advanced stages and presents a significant challange for surgical removal. Doctor might also prescribe it for HNC that has relapsed (came back) or spread to the other organs.

    Classical Hodgkin Lymphoma

    Approved for adults and children with Hodgkin Lymphoma (HL), in following two scenarios:

    • Lymphoma has not responded to treatment (refractory);
    • HL Cancer came back(relapsed) after trying two or more different treatment regimens;
    • In children for the refractory Hodgkin Lymphoma after one or more prior lines of treatment has failed
    • For relalps og HC in children after first line of treatment has failed

    Primary Mediastinal Large B-cell Lymphoma

    If two or more prior lines of therapy fail, oncologists might try pertulizumab for cases of refractory B-cell lymphoma.

    Bladder and Urinary Tract Cancer

    Doctors prescribe pertulizumab for advanced or challenging cases of Urinary truct cancers:

    • For patients who do not tolerate specific anti-cancer agents, like cisplatin;
    • If cancer has spread to other organs;
    • For advaced cases, when the tumor poses a challange for surgical removal.

    Stomach (gastric) Cancer

    Used in combination with specific chemotherapy as a first-line treatment for specific cases of stomach cancer:

    • locally advanced gastric tumors that cannot be removed by surgery;
    • gastric or gastroesophageal junction (GEJ) cancers, that have spread to other organs and have specific HER-2 receptor on the surface of their cells.

    Esophageal Cancer

    Oncologist may try it to treat locally advanced or metastatic cancer of the esophagus or GEJ.

    Cervical Cancer

    Doctors prescribe it for cervical cancer that has returned or spread, expresses PD-L1, and has progressed during or after chemotherapy.

    Onclogists use it as a first line for persistent, recurrent, or metastatic cervical cancer when combined with chemotherapy (with or without bevacizumab);

    Liver Cancer

    Onclogist might prescribe it for patients who previously took sorafenib.

    Merkel Cell Skin Cancer

    Approved for adults and children with Merkel cell carcinoma (MCC) for challenging cases:

    • MMC has returned;
    • Cancer has spread to other organs.

    Kidney Cancer

    Oncologists would try it as first line for advanced kidney cancer in combination with either axitinib or lenvatinib. Some doctors would also use pertolizumab for replases of kidney cancer or metastatic cases.

    Uterine (endometrial) Cancer

    Indicated for advanced endometrial cancer that cannot be cured by surgery or radiation, where it may be given alone or in combination with lenvatinib.

    Cutaneous Squamous Cell Carcinoma

    Doctors might try it for this type of skin cancer for relapsing or metastatic cases.

    Triple-Negative Breast Cancer

    Some advanced cases of breats cancer might benefit from pembrolizumab treatment.

    How is Pembrolizumab Given?

    Pembrolizumab is administered exclusively by trained healthcare professionals in specialized clinic or hospital.

    Here some key features:

    • The drug is administrated via IV line (in the veins);
    • Infusion is around 30 minutes to complete;
    • Your doctor would probably offer you a schedule tailored to the your specific needs. The most common one is either once every 3 weeks or once every 6 weeks;
    • Your medical team would check up on you regularly during the drip to monitor for potential side effects.

    How Does Pembrolizumab Work?

    Structurally, pembrolizumab is a monoclonal antibody, large Y-shaped protein structure, that can bind another protein with high affinity and specificity.

    Pembrolizumab binds PD-1 receptors on the surface of immune cells called T-cells, preventing its interaction with PDL-1 of a cancer cell.

    Role of PD-1

    When the PD-1 protein on a T-cell connects with PD-L1 or PD-L2 on a cancer cell, it signals the T-cell to switch off or ignore the cancer cell. This interaction allows cancers to evade immune attack and survive.

    PD-1 and PD-L1 interaction

    Pembrolizumab prevents PDL-1 from linking to PD-1

    Pembrolizumab is specifically engineered to attach to and block the PD-1 protein located on the T-cells. By physically obstructing this connection point, it prevents PD-L1 and PD-L2 from linking to PD-1 and activate their escape mechanism.

    Without PD-1 – PD-L1 signal T-cell identifies tumor as a foreign structure and does the rest of the job destroying the cancer cell.

    Side Effects of Pembrolizumab

    Common Side Effects of Pembrolizumab

    Common side effects include:

    • fatigue or muscle weakness;
    • muscle or joint pain;
    • rash or blistering;
    • itchy skin;
    • decreased appetite;
    • nausea, and diarrhea.

    Less Common but More Serious Side Effects

    Because pembrolizumab boosts your immune system’s activity, it might also cause collateral damage to healthy organs and tissues, which might be mistakenly ttacked by immune system.

    These side affects are inlammatory in their nature, range from mild asymptomatic to severe (please, read “when to seek medical attention”) and usually limited to one organ (organ-specific).

    Scientists call them immune-related adverse events (irAEs) and they are a feature for a broader group of immunetherapeutic agents.

    When to Seek Immediate Medical Attention?

    Pembrolizumab and Organ-Specific Inflammation

    Your immune system could potentially target various organs. Watch for these signs:

    • Lungs (Pneumonitis). Symptoms include a new or worsening cough, chest pain, or shortness of breath, requiring prompt medical evaluation;
    • Large Intestines (Colitis). Signs are diarrhea (which might be severe, watery, or more frequent than usual), stools containing blood or mucus, black and tarry stools, or significant stomach pain or tenderness; Do not attempt to treat diarrhea yourself without consulting your doctor;
    • Liver (Hepatitis). Look for yellowing of the skin or the whites of your eyes (jaundice), dark urine resembling tea, nausea or vomiting, pain in the upper right part of your abdomen, or bruising or bleeding more easily than normal; Unusual fatigue can also be a sign;
    • Kidneys (Nephritis). Symptoms involve changes in urination frequency or amount, blood in the urine, swelling, particularly in the ankles, or loss of appetite;
    • Heart (Myocarditis). Be alert for chest pain, shortness of breath, irregular heartbeats or palpitations, significant fatigue, or swelling in your ankles or legs;
    • Brain or Nerves (Encephalitis, Meningitis, Neuropathies, Myasthenia Gravis). Watch for headache, fever, confusion, excessive sleepiness, memory issues, seizures, a stiff neck, severe muscle weakness (like drooping eyelids, difficulty swallowing), numbness or tingling sensations, vision changes (double vision), or hallucinations;
    • Eyes (Uveitis, Iritis). Report any changes in your vision, blurry vision, eye pain, or eye redness;
    • Myositis or Arthritis. Let your doctor know about severe or persistent muscle pain or weakness, or joint pain, stiffness, or swelling. It might be a signs of inflammation if joints (arthritis) or muscles (myositis).

    Endocrine System Complications of Pembrolizumab

    Pembrolizumab can affect glands that produce hormones:

    • Thyroid gland. Unusual tiredness or lack of energy, changes in weight (gain or loss), feeling excessively cold or hot, rapid heartbeat, increased sweating are common signs of thyroid imbalance.
    • Pituitary gland. Pituitary is a small gland in your brain that controls how other gland work. The symptoms might vary from low sex drive and infertility to palpitation and heat intolerance.
    • Adrenal glands. Muscle wasting and weight loss, feeling dizzy or fainting, low blood pressure might indicate you have a deficiency of one of adrenal hormone. Please, contact your medical team if you expirience some of the symptoms.
    • Pancreas (diabetes). Muscle weakness, increased thirst or hunger, frequent urination are synmptoms to watch for.

    Skin Complications of Pembrolizumab

    Skin reactions like itchy skin or blistering are quite common.

    Check your skin regularly while taking pembrolizumab for the signs of more serious skin complications:

    • peeling skin;
    • painful sores or ulcers, especially if they occur in the mouth, nose, throat, or genital area;
    • Painful redness of teh skin and rapisly spreading blisters toghther with fever might indicate Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

    Both SJS and TEN are rare but life threatening complicatiosn and requre immidiate medical attention.

    Infusion Reactions

    Reactions can occur during or shortly after the infusion of pembrolizumab. Symptoms might include chills or shaking, itching, rash, flushing, shortness of breath or wheezing, dizziness, fever, or feeling faint; Your healthcare team will monitor you closely for these;

    Other Serious Complications

    Less common but potentially severe issues include:

    • Blood Disorders: Your immune system might attack blood cells, leading to conditions like hemolytic anemia (destruction of red blood cells) or aplastic anemia (body doesn’t produce enough new blood cells), or another rare condition called hemophagocytic lymphohistiocytosis (HLH), involving excessive immune activation; Symptoms can include fatigue, pale skin, shortness of breath, fever, bruising, or swollen lymph nodes;
    • Stem Cell Transplant Complications: If you have received, or plan to receive, an allogeneic stem cell transplant (using donor cells), pembrolizumab given before or after the transplant can increase the risk of serious complications like graft-versus-host disease (GVHD), where the donor cells attack your body, which can be life-threatening; Ensure your transplant team and oncologist are aware of all treatments received;

    Remember: This is not a complete list of all possible side effects; Always communicate openly with your healthcare team about any symptoms you experience, no matter how minor they seem;

    Before Taking Pembrolizumab

    To ensure pembrolizumab is administered safely and effectively, a thorough discussion of your medical background with your doctor is crucial before initiating treatment; It is vital to inform your doctor if you:

    • Suffer from any immune system disorders, such as Crohn’s disease, ulcerative colitis, lupus, or rheumatoid arthritis;
    • Have undergone an organ transplant, particularly an allogeneic stem cell transplant (using cells from a donor);
    • Are scheduled to receive, or have previously received, an allogeneic stem cell transplant;
    • Have received radiation therapy to your chest area in the past;
    • Experience any lung or breathing difficulties;
    • Have pre-existing liver or kidney conditions;
    • Have issues with your thyroid, pituitary gland, adrenal glands, or pancreas, including diabetes;
    • Possess any other significant medical conditions;
    • Are pregnant, suspect you might be pregnant, or are planning pregnancy; Pembrolizumab poses risks to an unborn baby, so females capable of becoming pregnant must utilize effective contraception throughout the treatment period and for a minimum of 4 months following the final dose;
    • Are breastfeeding or intend to breastfeed; It remains unknown whether pembrolizumab passes into breast milk, therefore breastfeeding should be avoided during treatment and for 4 months after the last dose due to potential risks to the infant;
    • Have any known allergies, especially to pembrolizumab or its components;
    • Are currently taking any other medications, encompassing prescription drugs, over-the-counter medicines, vitamins, herbal remedies, or supplements;

    What Should I Avoid While Receiving Pembrolizumab?

    Based on safety guidelines for pembrolizumab and similar immunotherapy agents:

    • Avoid Becoming Pregnant. Due to the potential harm to a developing fetus, females who are able to conceive must use reliable birth control during the entire course of treatment and continue for at least 4 months after the final infusion.
    • Avoid Breastfeeding. Breastfeeding is not recommended during treatment and for 4 months following the last dose, owing to the potential risk for adverse effects in the nursing child.
    • Avoid Self-Managing Side Effects. Do not attempt to treat potential side effects like diarrhea, rash, or cough independently without first consulting your healthcare provider; It’s essential they evaluate the cause, particularly to rule out serious immune-related reactions requiring specific medical management.

    Always adhere to the specific instructions and precautions provided by your healthcare team regarding activities and lifestyle during your treatment period.

    Brand Name

    Pembrolizumab is marketed globally under the brand name Keytruda®;

    Similar Medications to Pembrolizumab

    Pembrolizumab is part of a class of cancer drugs known as immune checkpoint inhibitors, specifically targeting the PD-1/PD-L1 pathway; Other medications function through similar mechanisms, targeting PD-1, PD-L1, or the related CTLA-4 pathway, to enhance the immune response against cancer; These include:

    • Other PD-1 Inhibitors: 
    • PD-L1 Inhibitors: 
      • Atezolizumab (Tecentriq®);
      • Durvalumab (Imfinzi®);
      • Avelumab (Bavencio®);
    • CTLA-4 Inhibitors: 
      • Ipilimumab (Yervoy®);
      • Tremelimumab (Imjudo®);

    Although these drugs operate similarly, their approved uses (indications), dosing schedules, and specific side effect profiles can differ; Your oncologist will determine the most suitable immunotherapy agent based on your unique cancer type and overall health situation;

  • Nivolumab

    Nivolumab (OPDIVO®) is an anti-cancer medication, which doesn’t allow tumor cells to escape from the survelience of immune system

    What is Nivolumab?

    Nivolumab (pronounced ni-VOH-loo-mab) is a type of cancer treatment known as immunotherapy. It belongs to the group of “immune checkpoint inhibitor,” and even more specifically, a “PD-1 inhibitor“.

    Unlike traditional chemotherapy that directly attacks cancer cells, nivolumab works with your own immune system, essentially empowering it to recognize and fight the cancer more effectively.

    Think of it as taking the brakes off your immune cells so they can do their job better against the cancer.

    Nivolumab is a prescription medication given intravenously (as an infusion into a vein). Its most common brand name is OPDIVO®.

    What is Nivolumab Used For?

    Nivolumab is approved to treat several different types of cancer, often in advanced stages or when other treatments haven’t worked or are no longer working.

    All of these cancers express ligand PDL-1 to connect to PD-1 and evade immune attack:

    Skin Cancer (Melanoma)

    • To treat advanced melanoma (that has spread or cannot be removed by surgery), sometimes with ipilimumab, especially if not previously treated.
    • After surgery to completely remove melanoma and its metastases, to help prevent or delay the cancer from coming back (this is called adjuvant therapy).

    Lung Cancer (Non-Small Cell Lung Cancer – NSCLC)

    • To treat advanced NSCLC that has spread or grown after treatment with platinum-based chemotherapy. (If you have specific mutations like EGFR or ALK, you usually need to have tried targeted therapies first).
    • As a first treatment for advanced NSCLC, often combined with ipilimumab (sometimes depending on PD-L1 test results).
    • As a first treatment for metastatic NSCLC, combined with ipilimumab and platinum-based chemotherapy.
    • Before surgery for NSCLC (neoadjuvant therapy), combined with chemotherapy.

    Malignant Pleural Mesothelioma.

    • For untreated mesothelioma (cancer affecting the lining of the lungs/chest wall) that cannot be removed by surgery, given in combination with ipilimumab.

    Kidney Cancer (Renal Cell Carcinoma – RCC)

    • To treat advanced RCC that has spread or grown after treatment with therapies that block blood vessel growth (anti-angiogenic therapies).
    • As a first treatment for advanced RCC, combined with ipilimumab.
    • As a first treatment for advanced RCC (that cannot be treated with radiation/surgery or is metastatic), combined with cabozantinib.

    Head and Neck Cancer (Squamous Cell Carcinoma)

    • To treat advanced head and neck cancer when it grows or spreads during or after treatment with platinum-based chemotherapy.

    Hodgkin Lymphoma.

    • For cancer that has come back or spread after an autologous stem cell transplant (using your own stem cells) and treatment with brentuximab vedotin, OR after at least 3 kinds of treatment including an autologous stem cell transplant. (Note: This use was approved under Health Canada’s NOC/c policy, meaning ongoing studies are confirming its benefit).

    Colon or Rectal Cancer

    • For cancer shown by tests to be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), given in combination with ipilimumab, IF you have already tried treatment with specific chemotherapy combinations (fluoropyrimidine with oxaliplatin, or irinotecan) and the cancer has spread/grown or you can no longer tolerate that treatment.

    Esophageal Cancer.

    • After chemoradiation and surgery to remove the cancer (adjuvant therapy).
    • For advanced esophageal squamous cell carcinoma that tests positive for PD-L1, cannot be removed surgically, and has come back or spread. Sometimes given with chemotherapy or ipilimumab as a first treatment in the metastatic setting.

    Stomach Cancer (Adenocarcinoma type).

    • As a first treatment when the cancer cannot be removed by surgery, given in combination with chemotherapy (fluoropyrimidine and platinum).

    Bladder and Urinary Tract Cancer (Urothelial Carcinoma).

    • To help prevent cancer from returning after it was removed by surgery (adjuvant therapy), particularly if you are at high risk and may have had prior platinum chemotherapy. (Note: This use was approved under Health Canada’s NOC/c policy).
    • As a first treatment when the cancer has spread (metastatic) or cannot be removed by surgery, given in combination with cisplatin and gemcitabine chemotherapy.

    Important Note: Nivolumab is not currently known to be safe or effective for children under 18 years of age.

    How is Nivolumab Given?

    Nivolumab is administered via intravenous (IV) infusion. Patient receive the drip in the specilized clinic under supervision of health professional.

    Here some key

    • Duration. A standard infusion typically takes about 30 minutes.
    • Frequency. Depending on your specific cancer, the dose being used, and whether you’re receiving it alone or with other treatments, you’ll likely receive nivolumab every 2, 3, or 4 weeks. Your doctor will determine the exact schedule for you.
    • Combination Therapy Order. If you receive nivolumab with chemotherapy or ipilimumab, nivolumab is usually given first, followed by the other medication(s). If combined with cabozantinib (a pill), you’ll receive the nivolumab infusion first.
    • Appointments are Key: It’s very important to keep all your scheduled appointments for treatment. If you have to miss an appointment, contact your healthcare team immediately to reschedule.

    How Does Nivolumab Work?

    Nivolumab mechanism of action

    Your immune system has cells called T-cells that are designed to find and destroy threats like infections and cancer cells. However, cancer cells can be sneaky. They sometimes develop ways to “hide” from the immune system. One way they do this is by displaying a protein called PD-L1 on their surface.

    When PD-L1 on a cancer cell connects with a protein called PD-1 on your T-cells, it acts like a switch, telling the T-cell to turn off or leave the cancer cell alone. This is called an “immune checkpoint.”

    Nivolumab is designed to block the PD-1 protein on your T-cells. By blocking PD-1, nivolumab prevents the cancer cell’s PD-L1 from delivering that “off” signal. This action “releases the brakes” on the T-cells, allowing them to recognize the cancer cells as harmful and attack them.

    Read more about how does it work in our article “nivolumab mechanism of action“.

    Side Effects of Nivolumab

    Because nivolumab works by stimulating your immune system, its side effects are often related to inflammation caused by the immune system becoming overactive and potentially affecting healthy organs. These are sometimes called immune-related adverse events (irAEs).

    It’s crucial to remember that these side effects can occur during treatment and sometimes weeks or even months after your last dose.

    When to Call your Medical Team Immediately ?

    While many side effects are manageable, some can be serious or even life-threatening if not addressed promptly. Contact your healthcare team right away if you experience any of the following symptoms.

    Nivolumab and serious inflammation of other organs

    • Pneumonia.  New or worsening cough, chest pain, shortness of breath, difficulty breathing might be signs of inflamation developing inside your lungs.
    • Inflammation of the large intestine (Colitis). Diarrhea (watery, loose, or more frequent than usual), blood or mucus in your stool, black/tarry stools, severe stomach pain or tenderness. Do not self-meidicate, tell your doctor about problems with the loose or watery stool.
    • Liver inflammation (Hepatitis). Yellowing of the skin or whites of the eyes (jaundice), severe nausea or vomiting, pain on the right side of your stomach area, dark urine (tea-colored), unusual tiredness, bruising or bleeding easily.
    • Kidney Problems (Nephritis). When urine saddenly changes the color, becoming much darker, your face and hands are swollen, and you have a dull pain in your lower back, it might be signs of nephritis. Call your medical team immediately.
    • Brain and problems with nervous symptoms. Headache that doesn’t go away, coupled with fever, or a neural deficit (confusion, palsy, memory loss or coordination problems) are signs you have some neural side effects.
    • Heart Problems. Most common side efefct is an inflammation of heart muscles, called myocarditis. Common signs are chest pain, irregular heartbeat, shortness of breath, fatigue, swelling in the legs.

    Nivolumab and serious endocrine events

    • Hormone imbalances. 
      • Thyroid problems. Whe the thyroid is affected and stop profucing suffcient levels of hormones, you might expirience extreme tiredness or sleepiness, weight gain or loss, changes in mood or behavior (irritability, forgetfulness, depression, low sex drive).
      • Diabetes. Frequent urination, feeling thirsty, and muscle wasting are common symptoms of diabetes.
      • Pituitary gland. A small gland in your brain, that produces bunch of important hormones controlling how other glands in your body are working. A person might expirirence symptoms ranging from low sex drive (decreased libido) and infertility to weight gain, frequent urination or headaches.

    Skin, eye problem and infusion reactions

    • Skin Problems. Itchy skin is quite common in immunotherapy. Sometimes you might experience more disturbing skin side effects like blistering or peeling skin, painful sores or ulcers in the mouth, nose, throat, or genital area.
    • Severe Infusion Reactions. Some people might react on a drip. Chills or shaking, itching or rash, flushing, difficulty breathing, dizziness, fever, feeling like you might pass out during or shortly after the infusion.
    • Eye Problems. Blurry vision, sadden changes in clarity of your vision are two serius, but rare side effects. More benign changes, like “red eyes” or an itchy eye

    It is vital to report ANY new or worsening symptoms to your healthcare team promptly. Early detection and management are key to preventing serious complications.

    Common Side Effects

    These side effects are seen more frequently but are often less severe. They can vary depending on whether you receive nivolumab alone or in combination.

    • You take only Nivolumab: 
      • Fatigue (feeling tired or weak);
      • skin rash or itchy skin;
      • decreased appetite;
      • nausea, diarrhea;
      • joint pain.
    • Nivolumab with other medicines.:
      • fatigue;
      • skin rash or itching;
      • diarrhea, nausea or a vomiting, decreased appetite,
      • thyroid problems,
      • headache;
      • shortness of breath;
      • fever;
      • low white blood count;
      • muscle/bone/joint pain.

    Less Common or Rare Side Effects

    Besides the serious conditions listed under “When to Seek Medical Attention,” other less common but potentially serious side effects include:

    • Inflammation of muscles (myositis) or muscle breakdown (rhabdomyolysis).
    • Inflammation of the pancreas (pancreatitis).
    • Blood sugar problems (diabetes or ketoacidosis).
    • Changes in blood levels of calcium, potassium, magnesium, or sodium.
    • Rare blood conditions where the immune system attacks blood cells (autoimmune hemolytic anemia, aplastic anemia) or causes widespread inflammation (haemophagocytic lymphohistiocytosis).
    • Complications if you have an allogeneic stem cell transplant (using donor cells) after receiving nivolumab – these can be severe or fatal. Inform your transplant team if you’ve had nivolumab.

    This is not an exhaustive list of potential side effect, so you feel something is wrong, do not hesitate to talk with your medical team.

    Before Taking Nivolumab

    To ensure nivolumab is as safe and effective as possible for you, it’s crucial to have an open discussion with your healthcare team about your health history before you start treatment. Be sure to tell them if you:

    • Have any allergies, especially if you’ve ever had a reaction to nivolumab or any of its ingredients.
    • Tall about all medications you are taking
    • Have any autoimmune diseases (like Crohn’s disease, ulcerative colitis, lupus, rheumatoid arthritis, etc.), where the body’s immune system attacks itself.
    • If you expirience any problems with your lungs, liver, kidneys, or hormone glands (thyroid, pituitary, adrenals, pancreas).
    • Have melanoma of the eye.
    • If you have had an organ transplant, including a stem cell transplant using donor cells (allogeneic).
    • Have cancer that has spread to your brain.
    • Are taking any medications that suppress your immune system, such as steroids (like prednisone).
    • Have experienced serious side effects from other immunotherapies (like ipilimumab).

    Nivolumab and pregnancy

    Nivolumab can harm your unborn baby. Women who could become pregnant must use effective birth control during treatment and for at least 5 months after the last dose.
    Do not become pregnant while taking nivolumab.

    Nivolumab and breast-feeding

    Breast-feeding: It’s not known if nivolumab passes into breast milk, but due to the potential for serious side effects in the baby, you should not breast-feed during treatment.

    What Should I Avoid While Receiving Nivolumab?

    • Pregnancy and breast-feeding;
    • Self-treating side effects;
    • Stopping treatment abruptly or not missing a drip;
    • Driving/Operating machinery.

    Brand Names for Nivolumab

    The brand name for nivolumab is OPDIVO®.

    Similar Medications

    Nivolumab belongs to a class of drugs called immune checkpoint inhibitors. Other medications work in similar ways by targeting PD-1, PD-L1, or CTLA-4 to help the immune system fight cancer. These include:

    • Other PD-1 Inhibitors: Pembrolizumab (Keytruda®), Cemiplimab (Libtayo®)
    • PD-L1 Inhibitors: Atezolizumab (Tecentriq®), Durvalumab (Imfinzi®), Avelumab (Bavencio®)
    • CTLA-4 Inhibitors: Ipilimumab (Yervoy®) – often used in combination with nivolumab.

    While these drugs have similar mechanisms, they may be used for different types of cancer or have slightly different side effect profiles.

  • Adalimumab

    What is Adalimumab?

    Adalimumab helps to treat different autoimmune disorders – conditions, where the immune system attacks normal organs and tissues.

    To calm down immune aggression adalimumab blocks a specific protein called TNF-α. TNF-a plays a crucial role in various inflammatory diseases by keeping immune cells in an aroused state longer, promoting the release of other inflammatory signals.

    By halting TNF-a, adalimumab lessens inflammation and tissue damage, improving quality of life and slowing down disease progression.

    What is it used for?

    Adalimumab treats several autoimmune diseases, including:

    • Rheumatoid Arthritis. Doctors usually prescribe it for moderate to severe cases in adults toghether with other disease-modifying agents (methotrexate)
    • Juvenile Idiopathic Arthritis. Rheumatologists usually prescribe dalimumab for moderate to severe cases of polyarticular Juvenile Idiopathic Arthritis in children aged 2 years and older.
    • Psoriatic Arthritis. Clinicians use it for cases of active psoriatic arthritis.
    • Ankylosing Spondylitis. Adalimumab has shown benefits in cases of active spondylitis. Doctors usually prescribe it toghether with other medications.
    • Crohn’s Disease. Adalimumab helps to reduce inflammation and improve quality of life for with Crohn’s Disease.
    • Ulcerative Colitis. Doctor use it for moderate to severe cases in adults and children aged 5 years and older.
    • Plaque Psoriasis. Adalimumab might be helpfull for some cases of psoriasis. With the advent of more powerful and safer alternatives, doctors less commonly prescribe to help with skin issues.
    • Hidradenitis Suppurativa. Adalimumab helps in moderate to severe cases of this skin disorder.

    How is Adalimumab given?

    Adalimumab is administered via subcutaneous injection (under the skin).

    • Patients or caregivers can perform injections after some training from a health professional.
    • There are two main injection sites:
      • A thigh
      • An abdomen;
        Patients usually rotate the site to avoid discomfort or scarring.
    • Adalimumab like other drugs is prone to individual reactions. Most people are doing just fine with theraupeutic doses of medications. Other might exhibit signs of intolerance which might lead to shifting to other drug.
    • To get nost of its effect, always do follow your doctor’s guidance and let him your medical team know if something goes not according to the plan.

    How does it work?

    Adalimumab is a monoclonal antibody targeting TNF-a.

    Some immune cells release TNF-α at the early stages of inflammation, signaling about potential threat. There are many functions TNF-a plays in the intricate autoimmune cascade:

    • It recruits more immune cells to the inflammation site
    • It makes immune cells more aggressive and aroused
    • It makes some immune cells release even more chemicals (chemocines) and

    Adalimumab inhibits the activity of TNF-a by binding with high affinity and specificity, neutrilizing it and removing from the inflmatory cascade.

    Read more about how does adalimumab work in this article.

    Side Effects of Adalimumab

    When to seek a doctor

    Contact your healthcare provider immediately if you experience:

    • Signs of infection (e.g., fever, chills, muscle aches)
    • Shortness of breath or persistent cough
    • Unusual bruising or bleeding
    • Numbness or tingling
    • Vision problems
    • Swelling of the face, lips, or tongue

    Common side effects

    • Injection site reactions (redness, itching, pain)
    • Headaches
    • Rash
    • Nausea
    • Upper respiratory infections (e.g., sinus infections)

    Rare side effects

    • Serious infections (e.g., tuberculosis)
    • Blood disorders
    • Liver problems
    • New or worsening heart failure
    • Certain types of cancer

    Before taking Adalimumab

    Inform your doctor if you:

    • Have an active infection or recurrent infections
    • Have tuberculosis or have been in close contact with someone with TB
    • Have or have had hepatitis B
    • Have any nervous system disorders (e.g., multiple sclerosis)
    • Are scheduled for surgery
    • Are pregnant, planning to become pregnant, or breastfeeding

    What should I avoid while receiving Adalimumab?

    • Avoid receiving live vaccines during treatment.
    • Limit exposure to infections; practice good hygiene and avoid close contact with sick individuals.
    • Consult your doctor before receiving any vaccinations.

    Brand names

    • Humira
    • Amgevita (biosimilar)
    • Cyltezo (biosimilar)
    • Hyrimoz (biosimilar)
    • Idacio (biosimilar)
    • Yuflyma (biosimilar)

    Similar medications

    Alternative TNF inhibitors include:

    • Enbrel (etanercept)
    • Remicade (infliximab)
    • Simponi (golimumab)
    • Cimzia (certolizumab pegol)

    Your doctor will recommend the best treatment based on your condition and medical history.

  • Bevacizumab

    What is Bevacizumab?

    Bevacizumab is a prescription medication used to treat various types of cancer.

    One of the key elements of cancer’s rapid growth is the blood supply. Bevacizumab hinders tumor’s ability to build new blood vessels and increase their supply of oxygen and nutrients.

    It belongs to the class of monoclonal antibodies (mAbs) and shares similar challenges and advantages with other mAbs.

    Doctors usually prescribe it together with other anti-tumor medications to boost the effect of chemotherapy.

    What is it used for?

    Bevacizumab is used to treat several types of cancer, including:

    • Cancer of your bowel, which has spread to other organs (metastatic colorectal cancer)
    • A particular type of lung cancer, called Non-small cellular lung cancer (NSCLC)
    • Glioblastoma (a type of brain tumor)
    • Kidney cancer (renal cell carcinoma)
    • Cervical cancer
    • Ovarian and fallopian tube cancer

    It is often prescribed when other treatments are not working effectively or as part of a combination therapy to improve patient outcomes.

    How is Bevacizumab given?

    Bevacizumab is administered as an intravenous (IV) infusion directly into the bloodstream. It is usually given in a hospital or clinic under the supervision of a healthcare professional. The infusion can take anywhere from 30 to 90 minutes, depending on the dosage and patient tolerance. Typically, patients receive this treatment every two to three weeks.

    How does it work?

    Bevacizumab blocks a vascular endothelial growth factor (VEGF). VEGF is a protein that promotes the growth of new blood vessels.

    To grow rapidly, tumors need a lot of oxygen and nutrients. They release VEGF to build their “supply network” of blood vessels, redirecting resources from the normal tissues and organs. Scientists call this process tumor angiogenesis and it is a key process for cancer:

    • To grow rapidly
    • To grow expansively
    • To spread to other organs and tissues (metastasis)

    Bevacizumab helps to slow down tumor angiogenesis. For more on this issue, please read an article bevacizumab mechanism of action.

    Side Effects of Bevacizumab

    1. When to seek a doctor
      Seek immediate medical attention if you experience:
      • Signs of internal bleeding (vomiting blood, black or bloody stools)
      • Severe stomach pain or swelling
      • Chest pain or difficulty breathing
      • Sudden vision changes or severe headaches
      • Unusual swelling or bruising
      • Symptoms of an allergic reaction, such as difficulty breathing, swelling of the face, lips, or tongue
    2. Common side effects
      • High blood pressure
      • Fatigue and weakness
      • Nosebleeds
      • Diarrhea or constipation
      • Decreased appetite
      • Dry skin or rash
    3. Rare side effects
      • Blood clots (which can lead to stroke or heart attack)
      • Kidney problems (including protein in the urine)
      • Perforations in the stomach or intestines (which can cause severe infections)
      • Wound healing complications
      • Serious infections or delayed recovery from surgery

    Before taking Bevacizumab

    Inform your doctor if you:

    • Have high blood pressure or heart disease
    • Have a history of bleeding disorders or blood clots
    • Have recently undergone surgery or plan to have surgery
    • Have kidney or liver disease
    • Are pregnant, planning to become pregnant, or breastfeeding

    Bevacizumab and pregnancy

    Bevacizumab can harm an unborn baby, so effective contraception is advised during treatment and for a period after treatment ends.

    What should I avoid while receiving Bevacizumab?

    • Avoid activities that put you at an increased risk of bleeding or injury.
    • Do not take aspirin, NSAIDs (like ibuprofen), or blood thinners without consulting your doctor.
    • Avoid pregnancy, as Bevacizumab may cause birth defects.
    • Avoid surgery shortly before or after receiving Bevacizumab, as it may slow wound healing.

    Brand names

    Bevacizumab is commonly sold under the brand names:

    • Avastin
    • Mvasi
    • Zirabev
    • Alymsys

    Similar medications

    Another medications that block VEGF:

    • Ramucirumab (Cyramza)
    • Aflibercept (Zaltrap)

    Drugs indicated for advanced stages of cancer:

    • Sorafenib (Nexavar)
    • Sunitinib (Sutent)

    If you do not tolerate Bevacizumab or it doesn’t work for you, your doctor will identify potential alternatives. Always ask your doctor first before deciding to stop medication or make adjustments in your treatment.