Bevacizumab
Overview
Bevacizumab is a humanized IgG1 monoclonal antibody that binds to and neutralizes vascular endothelial growth factor (VEGF), effectively inhibiting the formation of new blood vessels (angiogenesis) that tumors need to grow and spread. It is used in various solid tumors, including metastatic colorectal cancer, non-small cell lung cancer, glioblastoma, renal cell carcinoma, ovarian, fallopian tube, primary peritoneal, cervical, and hepatocellular cancer. Administered intravenously, bevacizumab is typically combined with chemotherapy agents to enhance anti-tumor activity and improve progression-free and overall survival.
Background and Date of Approval
Bevacizumab was approved by the U.S. Food and Drug Administration (FDA) in 2004 as the first angiogenesis inhibitor for metastatic colorectal cancer when added to standard chemotherapy, a breakthrough based on trial data showing extended survival. Its indications expanded over the years to include non-squamous non-small cell lung cancer, glioblastoma, renal cell carcinoma, ovarian and related cancers, cervical cancer, and hepatocellular carcinoma. European approval followed shortly after, and bevacizumab remains a key component in oncologic treatment protocols. It also ranks among the World Health Organization’s Essential Medicines in oncology for its broad impact.
Uses
Bevacizumab is indicated in metastatic colorectal cancer when combined with fluoropyrimidine-based chemotherapy, both as first-line and second-line therapy. It contributes to improved survival and tumor control in non-squamous non-small cell lung cancer when used with carboplatin and paclitaxel. It is approved for recurrent glioblastoma, advanced renal cell carcinoma, and several gynecologic cancers including epithelial ovarian, fallopian tube, and primary peritoneal cancer, typically alongside chemotherapy. In hepatocellular carcinoma, bevacizumab is combined with targeted agents, offering a vital option for unresectable disease. These approved uses underscore its role across diverse tumor types driven by VEGF-mediated angiogenesis.
Administration
Bevacizumab is administered via intravenous infusion, often every two to three weeks depending on the indication and dosing regimen. Initial infusion typically lasts around 90 minutes, and if tolerated, subsequent infusions may be administered over 30 to 60 minutes. Treatment continues until disease progression or unacceptable toxicity. Healthcare professionals should monitor patients closely for infusion-related reactions, adjust based on tolerability, and coordinate administration within established chemotherapy cycles.
Side Effects
Common side effects of bevacizumab include elevated blood pressure, fatigue, headache, epistaxis, proteinuria, dry skin, and mild hemorrhagic events. Patients may also experience gastrointestinal discomfort, taste alterations, and upper respiratory symptoms. These effects often require management with supportive measures, dose monitoring, and blood pressure control to maintain adherence and safety during therapy.
Warnings
Bevacizumab carries risk of serious adverse events including gastrointestinal perforation, wound healing complications, severe bleeding, arterial and venous thromboembolism, hypertensive emergencies, reversible posterior leukoencephalopathy syndrome (PRES), and renal impairment. A meta-analysis noted an increase in fatal adverse events when combined with certain chemotherapies. Pregnancy must be avoided during therapy due to risk of embryo-fetal harm. Risk-benefit balance should guide treatment decisions in patients with comorbidities or surgical plans.
Precautions
Caution is advised in patients with poorly controlled hypertension, recent surgery, bleeding disorders, or impaired wound healing potential. Baseline and periodic monitoring of blood pressure, urine protein, and organ function are essential. Bevacizumab may delay wound healing, so clinicians should plan treatment around surgical timelines. There are no common pharmacokinetic interactions, but combination with other toxic therapies requires careful monitoring and coordination.
Expert Tips
Ensure baseline evaluation of cardiovascular and renal status before initiating bevacizumab. Educate patients to recognize signs of serious side effects such as severe abdominal pain, bleeding, or neurological symptoms. Develop a plan for blood pressure management and prophylaxis for dermatologic issues. Coordinate with surgical teams to schedule dosing around procedures. Pharmacists should verify dosing schedules and infusion setup and counsel patients on monitoring and side effect reporting.
FAQs
What is Bevacizumab?
How is it administered?
What are the common side effects?
Is there a serious risk of complications?
Can it be used during surgery?
References
1) https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab
2) https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/bevacizumab
3) https://www.gene.com/download/pdf/avastin_prescribing.pdf
4) https://www.medicines.org.uk/emc/files/pil.3885.pdf
5) https://chemocare.com/chemotherapy/drug-info/bevacizumab.aspx