Published: September 2011

Premature ovarian failure with Avastin

Prescriber Update 32(3): 24
September 2011

Prescribers are advised to discuss the possibility of ovarian failure with all female patients prior to treatment with Avastin. Patients should also be monitored for the development of signs and symptoms of ovarian failure during treatment.

This advice follows the publication of a recent study, NSABP-C08, which found ovarian failure occurs commonly in association with Avastin use.1 Although ovarian failure is a well recognised complication of chemotherapy, it has not previously been reported in clinical trials of Avastin. Prescribers are advised to refer to the Avastin data sheet for the full prescribing information, available at:

Study NSABP-C08 was designed to evaluate the use of Avastin with a novel chemotherapy agent (mFOLFOX6) for the treatment of colon cancer. This study found a substantially higher incidence of ovarian failure in premenopausal women treated with Avastin + mFOLFOX6 (39%) compared to mFOLFOX6 alone (2.6%). Ovarian function returned in 86% of women after Avastin was discontinued.

Avastin (bevacizumab) is a recombinant monoclonal antibody that inhibits tumour angiogenesis and tumour growth. Avastin is approved for use in New Zealand for the treatment of various cancers including colorectal cancer, renal cell cancer, non-squamous non-small cell lung cancer, breast cancer, and high grade malignant glioma.

Patients with ovarian failure usually present with amenorrhoea (or irregular menses) with or without symptoms of oestrogen deficiency (such as hot flushes, night sweats, and emotional lability).2 Medical intervention may be required for symptom control and to prevent the long term consequences of oestrogen deficiency, such as osteoporosis.

  1. Study NSABP C-08, a phase III trial in adjuvant treatment of mFOLFOX +/- Avastin in patients with colon cancer. Currently not published.
  2. Rebar R W .2009. Premature Ovarian Failure. Obstetrics and Gynecology 113: 1355-1363.