Treatment Name: BCP (Bevacizumab + Carboplatin + Paclitaxel)

BCP (Bevacizumab + Carboplatin + Paclitaxel) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does BCP (Bevacizumab + Carboplatin + Paclitaxel) work?

Both carboplatin and paclitaxel are chemotherapy drugs designed to kill and slow the growth of cancer cells.
Bevacizumab is a drug designed to slow the growth of cancer cells by decreasing the spread of blood vessels carrying nutrients to cancer cells.


B – Bevacizumab
C – Carboplatin
P – Paclitaxel (Taxol®)

Goals of therapy:

BCP is given as a first-line treatment to patients with advanced or metastatic NSCLC. BCP may help relieve symptoms of lung cancer and slow the progression of lung cancer, but it is not commonly given with the goal of cure.

Schedule

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How is BCP therapy for NSCLC given?

  • Bevacizumab intravenous (I.V.) infusion over 90 minutes on Day 1 of Cycle 1
    • Then over 60 minutes for Cycle 2, if no infusion reactions occur
    • Then over 30 minutes for Cycles 3 and on, if no infusion reactions occur
  • Carboplatin I.V. infusion over 30 minutes on Day 1
  • Paclitaxel I.V. infusion over 3 hours on Day 1

Estimated total infusion time for this treatment:

  • Up to 6 hours for Cycle 1, Day 1; as short as 5 for the first day of next cycles if well tolerated
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

BCP is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

BCP is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 6 times, depending upon the stage of the disease. Duration of therapy may last up to 5 months, depending upon response, tolerability, and number of cycles prescribed.


Click here for the common BCP starting doses.

Side Effects

What are the most common side effects from BCP for NSCLC?

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of BCP are shown here. Side effects sometimes have percentage ranges [example: 6 – 18%] because they differed between clinical studies:

Importantly, not all people who experience a side effect from BCP will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid treatment with a certain medication altogether.

Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.

After starting treatment with BCP, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.

Watch videos on common BCP therapy side effects below

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingBleedingBleedingDiarrheaDiarrheaFatigue Fatigue Neutropenic FeverNeutropenic FeverHair LossHair LossAnemiaAnemia

Monitoring

How often is monitoring needed?

Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), urine protein levels, plus any others your doctor may order.

How often is imaging needed?

Imaging may be checked before treatment and during cancer treatment if there are concerns for disease progression or side effects. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?

Depending upon the results, your doctor may advise to continue BCP as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.

 

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

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Questions to ask your DoctorNursePharmacist

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        Questions to ask your NurseDoctorPharmacist

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              Questions to ask your PharmacistDoctorNurse

                    ChemoExperts Tips

                    What are the most important things to know about BCP while receiving therapy?

                    • Bevacizumab may lead to increases in blood pressure after starting therapy. If you currently are taking medications to control blood pressure, the doses of these medications may need to be adjusted or you may need to take additional medications to help control blood pressure
                    • Tell your doctor if you plan on having any surgeries while on therapy with bevacizumab as it can delay wound healing from the surgery and possibly lead to complications
                    • Paclitaxel tends to cause infusion reactions that can be related to the cremophor that is used in the IV formulation. Patients may receive several medications prior to receiving paclitaxel (this is known as "premedication") to decrease the risk of infusion reactions. Common pre-medications given are a histamine-2 blockers such as famotidine (Pepcid®) or ranitidine (Zantac®), a histamine-1 blocker such as diphenhydramine (Benadryl®), and a corticosteroid such as dexamethasone
                    • Carboplatin hypersensitivity reaction can be severe. This reaction is most common after the 6th cycle, but can happen after any dose. Some institutions may use "desensitization protocols" to allow a person to keep receiving carboplatin after they have had a reaction. Desensitization is used if someone is receiving a good response from carboplatin, or if few other chemotherapy options are available
                    • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
                    • Clinical trials may exist for NSCLC. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

                    Patient Assistance & Co-payment Coverage

                    Patients under the age of 65 years, or those with private insurance plans:
                    If you have insurance and are looking for patient assistance or copay assistance for BCP (Bevacizumab + Carboplatin + Paclitaxel), we have provided links that may help.

                    Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for BCP (Bevacizumab + Carboplatin + Paclitaxel). Depending upon your income, they may be able to help cover the cost of:

                    • Bevacizumab
                    • Carboplatin
                    • Paclitaxel

                    For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

                    • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

                    Medicare and Medicaid patients (Patients 65 years or older):
                    The clinic providing treatment will likely pre-authorize medications and immune therapies such as BCP (Bevacizumab + Carboplatin + Paclitaxel) and are the best source to help you understand drug cost.

                    • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

                    Emotional Wellness

                    What is Emotional Wellness?
                    Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

                    Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

                    Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

                    Learn more about pursuing emotional wellness while receiving treatment with BCP (Bevacizumab + Carboplatin + Paclitaxel)

                    Individual Drug Label Information

                    Bevacizumab (Avastin®, Mvasi®, Zirabev®, Alymsys®, Avzivi®, Vegzelma®)

                    • Bevacizumab is an intravenous (I.V.) drug
                    • Use extreme caution in patients with a history of stomach and intestine perforations or disorders
                    • Do not use 28 days before or after any surgery
                    • Bleeding is more likely in patients taking this drug
                    • Bevacizumab treatment may be delayed or stopped for: surgery, high blood pressure, protein in urine, severe infusion reactions
                    General Bevacizumab Side Effects
                    • Infusion reactions: usually does not happen after first successful dose
                    • Bleeding
                    • Blood clots
                    • Stomach and intestinal problems
                    • Poor wound healing
                    • High blood pressure
                    • Protein leaking from kidneys into urine
                    • Avoid during pregnancy, Bevacizumab is known to cause fetal harm
                    • Ovarian failure
                    • Click on the bevacizumab package insert below for reported side effects and possible drug interactions

                    Side Effect Videos
                    BleedingBleedingBlood ClotsBlood Clots

                    See DailyMed package insert.

                    Carboplatin (Paraplatin®)

                    • Carboplatin is an intravenous infusion 
                    • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
                    • This drug should not be used during pregnancy, it may cause fetal harm
                    General Carboplatin (Paraplatin) Side Effects:  
                    • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
                    • Nausea and vomiting is common but can be prevented by taking certain pre-medications
                    • Hair loss
                    • Constipation and/or diarrhea
                    • Pain
                    • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
                    • Can cause liver damage at high doses 
                    • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
                    • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

                    Side Effect Videos
                    Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

                    See DailyMed package insert.

                    Paclitaxel (Taxol®)

                    • Paclitaxel is an intravenous infusion
                    • There is a risk for serious infusion reactions such as trouble breathing, low blood pressure, severe swelling, or hives. These reactions are due to a component in the solution called Cremophor. You will receive several medications before receiving paclitaxel to decrease the risk of experiencing an infusion related reaction that include: a corticosteroid, diphenhydramine (Benadryl), and histamine-2 antagonists (Zantac or Pepcid).Patients who experience these type of severe reactions should not be rechallenged with paclitaxel.
                    • This drug can cause low white blood cell counts. Complete blood counts (CBC) will be checked before each treatment to make sure your white blood cells are at a safe enough to use this drug
                    • Dosage adjustments may be required for liver dysfunction, nerve pain or toxicity, low white blood cells, or low blood platelets
                    • Nerve pain usually starts as tingling or a "pins and needles" feeling in the fingers or toes, but can worsen over time and lead to numbness. It is important to notify the doctor if there are any signs of nerve damage. If caught early, this is typically reversible but can become permanent if not addressed
                    • Interacts with certain antifungal, blood pressure, cholesterol, erectile dysfunction, sedative, antibiotic, and anti-seizure medications.  Ask your doctor or pharmacist to review your medications for any possible interactions
                    • Known interaction with grapefruit or grapefruit juice. Avoid eating grapefruit and drinking grapefruit juice as they may increase your risk of experiencing side effects
                    • Avoid the natural supplement St. John’s Wort as this can possibly decrease the effectiveness of paclitaxel
                    • Injection site skin reactions can occur:  itching, skin infection, skin falling off, skin death, and redness. Report any of these to your physician, even if this occurs several days after an infusion
                    • Can cause fetal harm; this drug should not be used during pregnancy.  Women should avoid becoming pregnant while on this drug
                    General Paclitaxel (Taxol) Side Effects
                    • Low blood neutrophil count (neutropenia)
                    • Low white blood cells
                    • Nerve pain and general pain
                    • Low red blood cells and related fatigue
                    • Infusion reactions - hypersensitivity
                    • Hair loss
                    • Nausea
                    • Diarrhea
                    • Mouth sores
                    • Low blood pressure
                    • Liver problems
                    • Constipation
                    • Fever and infection
                    • Bleeding
                    • Injection site reactions
                    • Nail discoloration; usually reversible once paclitaxel is stopped
                    • Click on the paclitaxel (Taxol) package insert below for all manufacturer reported side effects and possible drug interactions

                    Side Effect Videos
                    DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

                    See DailyMed package insert.

                    References

                    1) Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006;355:2542-2550


                    2) Johnson DH, Fehrenbacher L, Novotny WF, et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol 2004;22:2184-2191


                    3) Cohen, M.H., Gootenberg, J, Keegan, et al. (2007), FDA Drug Approval Summary: Bevacizumab (Avastin®) Plus Carboplatin and Paclitaxel as First-Line Treatment of Advanced/Metastatic Recurrent Nonsquamous Non-Small Cell Lung Cancer. The Oncol, 12: 713-718

                    Created: October 12, 2021 Updated: October 12, 2021

                    What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

                    What is Non-Small Cell Lung Cancer?
                    A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

                    NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

                    What does Cure mean?

                    The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

                    Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

                    Common Starting Doses

                    • Bevacizumab 15 mg/kg I.V. infusion over 90 minutes on Day 1 of Cycle 1
                      • then over 60 minutes for Cycle 2, if no infusion reactions occur
                      • then over 30 minutes for Cycles 3 and on, if no infusion reactions occur
                    • Carboplatin AUC 6 I.V. infusion over 30 minutes on Day 1
                    • Paclitaxel 200 mg/m2 I.V. infusion over 3 hours on Day 1

                    Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

                    Clinical Studies

                    1) Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006;355:2542-2550


                    2) Johnson DH, Fehrenbacher L, Novotny WF, et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol 2004;22:2184-2191


                    3) Cohen, M.H., Gootenberg, J, Keegan, et al. (2007), FDA Drug Approval Summary: Bevacizumab (Avastin®) Plus Carboplatin and Paclitaxel as First-Line Treatment of Advanced/Metastatic Recurrent Nonsquamous Non-Small Cell Lung Cancer. The Oncol, 12: 713-718

                    What is a CBC?

                    A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

                    Common uses:
                    1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

                    2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

                    3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

                    What is a CMP?

                    A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

                    Electrolytes & Acid/Base status:
                    1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

                    Kidney Function:
                    5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

                    Liver Function:
                    7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

                    Blood sugar:
                    13) Serum glucose

                    Calcium:
                    14) Serum calcium