Is Bevacizumab compatible with breastfeeding? Do we have alternatives for Bevacizumab?

Bevacizumab

July 1, 2015 (Low Risk)

Human-like monoclonal antibody (IgG1 immunoglobulin) produced by DNA recombinant technology. Action is by blockage of endothelial growth factor. Has been used for treatment of several types of cancer. Useful for treatment of eye macular degeneration secondary to choroidal neovascularization.

Because of a high molecular weight and a protein structure, excretion into breast milk and absorption by infant's gut are highly unlikely.

Intravitreal injection: because small doses used and low level observed in the plasma and because neither trace in breast milk nor side-effects in the infant have been reported, treatment is likely safe while breastfeeding.

Intravenous administration should be avoided mostly during neonatal period and in prematurity cases.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • بيفاسيزوماب (Arabic)
  • Бевацизумаб (Cyrillic)
  • 贝伐珠单抗 (Chinese)
  • ベバシズマブ (Japanese)

References

  1. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013Abstract
  2. Ehlken C, Martin G, Stahl A, Agostini HT. Reduction of vascular endothelial growth factor a in human breast milk after intravitreal injection of bevacizumab but not ranibizumab. Arch Ophthalmol. 2012Abstract Full text (link to original source) Full text (in our servers)
  3. Tarantola RM, Folk JC, Boldt HC, Mahajan VB. Intravitreal bevacizumab during pregnancy. Retina. 2010Abstract