Is Bevacizumab Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Bevacizumab? Is Bevacizumab safe for nursing mother and child? Does Bevacizumab extracts into breast milk? Does Bevacizumab has any long term or short term side effects on infants? Can Bevacizumab influence milk supply or can Bevacizumab decrease milk supply in lactating mothers?

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.

No information is available on the intravenous use of bevacizumab during breastfeeding. Because bevacizumab is a large protein molecule with a molecular weight of about 149,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.[1] Until more data become available, intravenous bevacizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during bevacizumab therapy and for 6 months following the last dose. Several infants have been breastfed, apparently without noticeable harm, following maternal intravitreal bevacizumab injections. Bevacizumab was undetectable in the milk of one mother, but vascular endothelial growth factor (VEGF) levels in breastmilk were suppressed following the injection. Because the breast and neonatal intestine have VEGF receptors, some authors recommend use of intravitreal ranibizumab, which does not appear to depress milk VEGF levels.[2]

A 33-year-old woman was treated with 14 intravitreal bevacizumab injections of 1.25 mg over a 20-month period. Five of these injections were given while she was breastfeeding (age of infant not stated). No mention was made of adverse effects in this infant, but she became pregnant again, received 3 additional injections, and delivered an infant who developed normally at 12 months of age.[4] A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Her breastfed infant was 12 weeks old at the start of therapy. No mention was made of adverse effects in this infant.[2] Two women received intravitreal injections of bevacizumab 1.25 mg at 1- to 2-month intervals while breastfeeding. They breastfed their infants (extent not stated) for several months. No adverse effects in the infants were noted.[3]