Hospital Pharmacy - June 2017 - 394

717622
research-article2017

HPXXXX10.1177/0018578717717622Hospital PharmacyMayer et al

Cancer Chemotherapy Update

Cancer Chemotherapy Update:
Bevacizumab, Etoposide, and Cisplatin
Regimen for Refractory Brain Metastases

Hospital Pharmacy
2017, Vol. 52(6) 394-399
© The Author(s) 2017
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https://doi.org/10.1177/0018578717717622
DOI: 10.1177/0018578717717622
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Seth A. Mayer1, Dominic A. Solimando2, and J. Aubrey Waddell3

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic
agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic
therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or
suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc, 4201
Wilson Blvd #110-545, Arlington, VA 22203, email: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University
of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar
Alexander Parkway, Maryville, TN 37804, email: waddfour@charter.net.
Regimen Name: Bevacizumab, etoposide, and cisplatin (BEEP)
Origin of Name: The regimen is named for the medications it contains: bevacizumab, etoposide, and cisplatin.

Comments

Use of systemic chemotherapy against central nervous system (CNS) tumors is limited by the inability of the drugs to
cross the blood-brain barrier. Despite this limitation, the combination of cisplatin plus etoposide has demonstrated moderate overall response in breast cancer patients with brain
metastases who have not received whole brain radiation.1,2
The addition of bevacizumab, a humanized recombinant
monoclonal antibody active against vascular endothelial
growth factor, has been shown to induce vascular normalization of brain metastases and potentiate the combined cisplatin
and etoposide antitumor effect.3-5

B. Etoposide
1. Use etoposide injection, 20 mg/mL.
2. Dilute with 5% dextrose in water or NS to a final
concentration of 0.2 mg/mL to 0.4 mg/mL.
3. Concentrations greater than 0.4 mg/mL are not
stable and may precipitate during infusion.
4. Stability varies based on concentration; 0.2 mg/
mL solutions are stable for 96 hours at room temperature, and 0.4 mg/mL solutions are stable for
24 hours at room temperature.
5. Do not refrigerate.
6. Etoposide injection contains polysorbate 80
which may cause leaching of diethylhexyl phthalate. Etoposide solutions should be dispensed in
glass or polyolefin containers.

Indications
The bevacizumab, etoposide, and cisplatin (BEEP) regimen
(see Table 1) has been studied as salvage treatment for breast
cancer-induced refractory brain metastases.3-5 Variations of
the 3-drug regimen are also used to treat extensive-stage
small cell and advanced non-small cell lung cancer.6-8
Current guidelines do not list BEEP as a recommended treatment for CNS metastases.9

C. Cisplatin
1. Use cisplatin injection, 1 mg/mL.

Drug Preparation
Follow institutional policies for preparation of hazardous
medications when preparing BEEP.
A. Bevacizumab
1. Use bevacizumab, 25 mg/mL injection.
2. Dilute in 100 to 250 mL of 0.9% sodium chloride
(NS) solution.

Do not mix or administer with dextrose-containing solutions. Bevacizumab may precipitate rapidly when bevacizumab is diluted with or mixed
in a dextrose-containing solution.10
Solutions diluted in NS are stable for up to 8
hours under refrigeration.

Walter Reed National Military Medical Center, Bethesda, MD, USA
Oncology Pharmacy Services, Inc, Arlington, VA, USA
3
The University of Tennessee Health Science Center, Maryville, USA
2

Corresponding Author:
Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc,
Arlington, VA, USA.
email: OncRxSvc@comcast.net

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