Bevacizumab — Drug Monograph

Brand names: Avastin, Mvasi, Zirabev, Vegzelma, Alymsys

Drug class: Monoclonal Antibody

Mechanism of Action

Recombinant humanized anti-VEGF (vascular endothelial growth factor) monoclonal antibody (IgG1). Binds to all VEGF-A isoforms, preventing interaction with VEGFR-1 and VEGFR-2 on endothelial cells. Inhibits tumor angiogenesis, reduces vascular permeability, and induces regression of tumor vasculature. "Normalizes" remaining vessels, improving delivery of co-administered cytotoxics.

FDA Indications

• Metastatic colorectal cancer — first/second-line with IV fluoropyrimidine-based chemotherapy
• Metastatic non-squamous NSCLC — first-line with carboplatin/paclitaxel
• Glioblastoma multiforme (GBM) — second-line monotherapy or with lomustine
• Metastatic renal cell carcinoma — with interferon alfa
• Recurrent ovarian cancer — with chemotherapy or as monotherapy
• Persistent/recurrent cervical cancer — with paclitaxel and cisplatin or paclitaxel and topotecan

Common Side Effects

• Hypertension (one of the most common; manage with antihypertensives)
• Proteinuria
• Neuropathy
• Impaired wound healing
• Fatigue
• Headache
• Epistaxis, minor bleeding
• Diarrhea, nausea

Clinical Pearl

Hypertension from bevacizumab is a pharmacodynamic effect (VEGF inhibition reduces nitric oxide production and increases peripheral vascular resistance). Adequate blood pressure control is essential — uncontrolled hypertension mandates dose hold. Ironically, hypertension development may be a positive biomarker for bevacizumab efficacy.

Related Therapies & Mechanisms

• Nivolumab (Opdivo) — HCC
• Pembrolizumab (Keytruda) — HCC
• Carboplatin (Paraplatin) — NSCLC
• Cisplatin (Platinol) — NSCLC