Drug Monograph
Avastin (Bevacizumab)
bevacizumab — recombinant humanised IgG1 monoclonal antibody
Pharmacokinetic Profile
Half-Life
~20 days
Metabolism
Proteolytic catabolism (like IgG)
Protein Binding
N/A (monoclonal Ab)
Volume of Distribution
2.9 L (central compartment)
Clearance
0.23 L/day (mean)
Clinical Information
Drug Class
Anti-VEGF monoclonal antibody
Available Forms
100 mg/4 mL & 400 mg/16 mL vials (25 mg/mL)
Route
IV infusion only
Renal Adjustment
Not studied
Hepatic Adjustment
Not studied
Pregnancy
May cause fetal harm; contraception 6 months post-dose
Lactation
Not recommended during treatment
Ovarian Failure Risk
34% vs 2% (with chemo)
Biosimilars Available
Yes (multiple approved)
Indications for Bevacizumab
| Indication | Approved Population | Therapy Type | Status |
|---|---|---|---|
| Metastatic colorectal cancer (mCRC) — 1st/2nd line | Adults | Combination with IV 5-FU–based chemotherapy | FDA Approved |
| mCRC — 2nd line after progression on bevacizumab | Adults | Combination with fluoropyrimidine-irinotecan or -oxaliplatin | FDA Approved |
| Non-squamous NSCLC — 1st line | Adults; unresectable, locally advanced, recurrent, or metastatic | Combination with carboplatin and paclitaxel | FDA Approved |
| Recurrent glioblastoma (GBM) | Adults | Monotherapy | FDA Approved |
| Metastatic renal cell carcinoma (mRCC) | Adults | Combination with interferon alfa | FDA Approved |
| Persistent, recurrent, or metastatic cervical cancer | Adults | Combination with paclitaxel + cisplatin, or paclitaxel + topotecan | FDA Approved |
| Epithelial ovarian / fallopian tube / primary peritoneal cancer | Adults; stage III/IV post-surgery; platinum-resistant; platinum-sensitive recurrent | Combination with various regimens (see dosing), followed by single-agent maintenance | FDA Approved |
| Hepatocellular carcinoma (HCC) | Adults; unresectable or metastatic; no prior systemic therapy | Combination with atezolizumab | FDA Approved |
Bevacizumab was first approved in 2004 for metastatic colorectal cancer and has since become one of the most broadly indicated oncology biologics. It functions as an anti-angiogenic agent by neutralising VEGF-A, thereby starving tumours of their blood supply. The drug is used across diverse solid tumour types, always administered intravenously and almost always in combination with cytotoxic chemotherapy or, in the case of HCC, with the immune checkpoint inhibitor atezolizumab. Notably, bevacizumab is not indicated for adjuvant treatment of colon cancer, as clinical trials showed no benefit in this setting.
Off-Label Uses
Hereditary haemorrhagic telangiectasia (HHT) — systemic bevacizumab for epistaxis and GI bleeding. Evidence quality: Moderate (randomised trial data).
Intravitreal injection for neovascular age-related macular degeneration — widely used off-label at 1.25 mg/0.05 mL; not FDA-approved for this route but extensively studied. Evidence quality: High (CATT trial).
Mesothelioma — in combination with cisplatin and pemetrexed. Evidence quality: Moderate (MAPS trial).
Dosing for Bevacizumab
Adult Dosing by Clinical Scenario
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| mCRC — 1st line with bolus-IFL | 5 mg/kg IV q2wk | 5 mg/kg IV q2wk | Until progression | Continue until disease progression or unacceptable toxicity |
| mCRC — with FOLFOX4 | 10 mg/kg IV q2wk | 10 mg/kg IV q2wk | Until progression | Studied in E3200; applicable to both first- and second-line settings per FDA indication |
| mCRC — 2nd line after bevacizumab-containing 1st line | 5 mg/kg q2wk or 7.5 mg/kg q3wk | Same | Until progression | Dose depends on chemotherapy backbone Bevacizumab continuation beyond progression (TML strategy) |
| Non-squamous NSCLC — 1st line | 15 mg/kg IV q3wk | 15 mg/kg IV q3wk | Until progression | Given with carboplatin + paclitaxel for up to 6 cycles, then bevacizumab monotherapy maintenance Squamous histology excluded due to fatal pulmonary haemorrhage risk |
| Recurrent glioblastoma | 10 mg/kg IV q2wk | 10 mg/kg IV q2wk | Until progression | Monotherapy; may be combined with lomustine |
| Metastatic renal cell carcinoma | 10 mg/kg IV q2wk | 10 mg/kg IV q2wk | Until progression | In combination with interferon alfa |
| Persistent / recurrent / metastatic cervical cancer | 15 mg/kg IV q3wk | 15 mg/kg IV q3wk | Until progression | With paclitaxel + cisplatin or paclitaxel + topotecan |
| Ovarian cancer — stage III/IV post-surgical resection | 15 mg/kg IV q3wk | 15 mg/kg IV q3wk | Up to 22 cycles total | With carboplatin + paclitaxel for up to 6 cycles, then single-agent maintenance Total treatment capped at 22 cycles or disease progression |
| Ovarian cancer — platinum-resistant recurrent | 10 mg/kg IV q2wk | 10 mg/kg IV q2wk | Until progression | With paclitaxel, PLD, or weekly topotecan. Alternative: 15 mg/kg q3wk with q3wk topotecan ≤2 prior chemo regimens |
| Ovarian cancer — platinum-sensitive recurrent | 15 mg/kg IV q3wk | 15 mg/kg IV q3wk single-agent | Until progression | With carboplatin + paclitaxel (6–8 cycles) or carboplatin + gemcitabine (6–10 cycles), then bevacizumab monotherapy |
| Hepatocellular carcinoma — 1st line | 15 mg/kg IV q3wk | 15 mg/kg IV q3wk | Until progression | Given after atezolizumab 1200 mg on same day Variceal evaluation recommended within 6 months before starting |
Clinical Pearl: No Dose Reductions
There are no recommended dose reductions for bevacizumab. Management of adverse reactions involves either withholding or permanently discontinuing the drug (see Dose Modifications table in the Side Effects section). The surgery-related rule is critical: do not initiate bevacizumab until at least 28 days after major surgery and the wound is fully healed, and withhold for at least 28 days before elective surgery (FDA PI).
Pharmacology of Bevacizumab
Mechanism of Action
Bevacizumab is a recombinant humanised IgG1 monoclonal antibody that selectively binds to human vascular endothelial growth factor A (VEGF-A) with high affinity, preventing its interaction with the VEGF receptors Flt-1 (VEGFR-1) and KDR (VEGFR-2) on the surface of endothelial cells. VEGF-A is the principal mediator of tumour angiogenesis, and its neutralisation by bevacizumab leads to regression of existing tumour microvasculature, normalisation of remaining tumour vessels (improving chemotherapy delivery), and inhibition of new blood vessel formation. The resulting reduction in tumour perfusion and interstitial pressure contributes to the enhanced cytotoxic effect observed when bevacizumab is combined with standard chemotherapy. Bevacizumab does not directly kill tumour cells; its anti-cancer activity is entirely mediated through its effects on the tumour vasculature and microenvironment.
ADME Profile
| Parameter | Value | Clinical Implication |
|---|---|---|
| Absorption | IV only; linear PK across 1–20 mg/kg; 90% of steady state reached by ~84 days; time to steady state ~100 days | First infusion over 90 min; second over 60 min if tolerated; all subsequent over 30 min if 60 min tolerated |
| Distribution | Vd central ~2.88 L (70 kg patient); males 3.25 L vs. females 2.66 L; limited extravascular distribution | Distribution largely confined to the vascular space, consistent with IgG behaviour; does not cross the BBB in clinically relevant concentrations |
| Metabolism | Proteolytic catabolism identical to endogenous IgG; non-specific elimination pathways plus target-mediated elimination by VEGF-expressing cells; no CYP450 involvement | No hepatic enzyme-based drug interactions expected; clearance higher in males (~0.262 L/day) than females (~0.207 L/day) and with higher tumour burden |
| Elimination | t½ ~20 days (range 11–50 days); CL ~9 mL/h (0.22 L/day) for 70 kg female; renal excretion not a significant route | Long half-life supports q2wk or q3wk dosing; clearance increases with body weight, lower albumin, and higher alkaline phosphatase |
Side Effects of Bevacizumab
≥10%Very Common
| Adverse Effect | Incidence | Clinical Note |
|---|---|---|
| Epistaxis | 20–27% | Most common haemorrhagic event; usually Grade 1 and self-limiting; reflects VEGF inhibition in nasal mucosa |
| Hypertension | 12–28% (all grades) | Grade 3–4 in 5–18% across studies; monitor BP every 2–3 weeks; treat with standard antihypertensives |
| Proteinuria | 20% (all grades in BO17705) | Grade 3–4 in 0.7–7%; monitor with urine dipstick; withhold for ≥2 g/24 h; discontinue for nephrotic syndrome |
| Headache | 16–24% | More frequent in RCC and GBM settings; usually mild |
| Fatigue / asthenia | 19–33% | Dose-related; more common with combination chemotherapy |
| Diarrhoea | 21% (all grades, mRCC); Grade 3–4 up to 34% with IFL | Incidence varies by chemotherapy backbone; largely driven by the concurrent cytotoxic regimen |
| Decreased appetite / weight loss | 20–36% | Most prominent in mRCC setting with IFN-alfa |
| Back pain | 12% (mRCC vs. 6% placebo) | Listed by FDA as >10% across studies; more common with IFN-alfa combination |
| Taste alteration (dysgeusia) | >10% | Listed by FDA as >10% across studies; class-effect of VEGF pathway inhibition |
| Lacrimation disorder | >10% | Listed by FDA as >10%; VEGF inhibition affects tear film homeostasis |
| Rhinitis / dry skin / exfoliative dermatitis | >10% | Class-effect of VEGF inhibition on mucosal and skin vasculature |
1–10%Common
| Adverse Effect | Incidence | Clinical Note |
|---|---|---|
| Deep vein thrombosis | 5–9% | Higher in mCRC; manage with anticoagulation; discontinue for Grade 4 VTE |
| Myalgia | ~5% excess (19% bev+IFN vs 14% IFN alone) | Reported in mRCC setting; largely IFN-driven, with modest bevacizumab-attributable excess |
| Stomatitis | 3–5% | Often related to concurrent chemotherapy rather than bevacizumab itself |
| Dysphonia | 5% | Reported primarily in mRCC setting |
| Infusion-related reactions | <3% (first dose); severe <0.4% | Less frequent than with other mAbs; manage with rate reduction or interruption |
SeriousSerious Adverse Effects (Regardless of Frequency)
| Adverse Effect | Estimated Frequency | Typical Onset | Required Action |
|---|---|---|---|
| GI perforation | 0.3–3% | Majority within first 50 days | Permanently discontinue; surgical consultation; highest risk with prior pelvic radiation |
| Fistula (including tracheoesophageal, vaginal, renal) | <1% to 1.8% | Most within 6 months of first dose | Discontinue for Grade 4 or any internal organ fistula; surgical management may be required |
| Serious haemorrhage (including fatal pulmonary haemorrhage) | Grade 3–5: 0.4–7% | Variable; squamous NSCLC: 31% fatal haemorrhage | Discontinue for Grade 3–4; do not use in squamous NSCLC; withhold for recent haemoptysis |
| Arterial thromboembolic events (MI, CVA, TIA) | Grade 3–5: 5% vs ≤2% | Any time during treatment | Permanently discontinue for severe ATE; increased risk if >65 years, diabetes, or prior ATE history |
| Venous thromboembolic events (PE, DVT) | Grade 3–4: 5–11% | Any time during treatment | Discontinue for Grade 4 (life-threatening); manage Grade 3 with anticoagulation |
| Hypertensive crisis / hypertensive encephalopathy | Rare | Variable | Permanently discontinue; emergency BP management |
| Posterior reversible encephalopathy syndrome (PRES) | <0.5% | 16 hours to 1 year after first dose | Permanently discontinue; MRI to confirm; symptoms usually resolve within days of stopping |
| Nephrotic syndrome | <1% | Median onset proteinuria: 5.6 months | Permanently discontinue; renal biopsy may show thrombotic microangiopathy |
| Wound healing complications / necrotising fasciitis | 15% vs 4% (with surgery) | Post-operative period | Discontinue; observe 28-day surgical window; necrotising fasciitis can be fatal |
| CHF / left ventricular dysfunction | Grade ≥3: 1% vs 0.6% | 1–6 months in 85% of cases | Permanently discontinue; not indicated with anthracycline-based chemotherapy; prior anthracycline: CHF 4% vs 0.6% |
| Ovarian failure | 34% vs 2% | During treatment | Counsel patients pre-treatment; recovery in only 22% after discontinuation; long-term fertility effects unknown |
DiscontinuationDiscontinuation Rates
Across all clinical studies
8–22% discontinued due to adverse reactions
Primary reasons: Haemorrhage, GI perforation, hypertension, proteinuria, wound complications, thromboembolic events
HCC (IMbrave150)
4.9% haemorrhage-related d/c
Key reasons: Haemorrhage (4.9%) and elevated transaminases (0.9%)
GI Perforation: Highest-Risk Populations
The incidence of GI perforation is highest in patients with a history of prior pelvic radiation (up to 3%) and in patients with ovarian cancer who have evidence of recto-sigmoid involvement. Patients should be carefully assessed for signs of GI perforation (abdominal pain, nausea, vomiting, constipation, fever) and the diagnosis should be suspected in any bevacizumab-treated patient presenting with an acute abdomen. Bevacizumab must be permanently discontinued if perforation occurs.
Drug Interactions with Bevacizumab
Bevacizumab is not metabolised via cytochrome P450 enzymes and demonstrates minimal pharmacokinetic interactions with commonly combined chemotherapy agents. Its primary interaction concerns are pharmacodynamic, related to additive vascular and haematological toxicity.
MajorAnthracyclines (doxorubicin, epirubicin)
MechanismAdditive cardiotoxicity; VEGF inhibition impairs cardiac repair pathways
EffectCHF rate 4% with prior anthracycline exposure vs. 0.6% without; LVEF decline 10% vs. 5%
ManagementBevacizumab is not indicated for use with anthracycline-based chemotherapy (PI Section 5.12)
FDA PIMajorSunitinib
MechanismDual VEGF pathway inhibition causing synergistic vascular toxicity
EffectMicroangiopathic haemolytic anaemia (MAHA) reported in clinical trials
ManagementAvoid concurrent use
FDA Safety CommunicationModerateAnticoagulants / Antiplatelet agents
MechanismBevacizumab increases haemorrhage risk; additive bleeding risk with anticoagulants
EffectIncreased risk of serious bleeding events
ManagementPatients on therapeutic anticoagulation were excluded from NSCLC trials; use with caution, monitor closely
FDA PIMinorIrinotecan / Carboplatin / Paclitaxel / IFN-alfa
MechanismNo clinically significant PK interaction identified in formal studies
EffectNo alteration in plasma concentrations of irinotecan/SN38, carboplatin, paclitaxel (note: 3/8 patients had lower paclitaxel at Day 63), or IFN-alfa
ManagementStandard combination dosing; no dose modifications for PK reasons
FDA PIMonitoring for Bevacizumab
- Blood PressureEvery 2–3 weeks during treatment; continue post-discontinuation
RoutineGrades 3–4 hypertension in 5–18%. Treat with standard antihypertensives. Withhold if severe and uncontrolled; permanently discontinue for hypertensive crisis or encephalopathy. - Urine ProteinDipstick at baseline and periodically; 24-h collection if ≥2+
RoutineWithhold for proteinuria ≥2 g/24 h; resume when <2 g/24 h. Discontinue for nephrotic syndrome. UPCR correlates poorly with 24-h protein; use 24-h collections for decisions. - Signs of GI PerforationEach cycle; highest risk first 50 days
Trigger-basedAssess for abdominal pain, nausea, vomiting, constipation, fever. Highest risk with prior pelvic radiation and bowel involvement in ovarian cancer. - Wound Healing / Surgical StatusPre-treatment and peri-operatively
Trigger-basedDo not initiate until ≥28 days post-surgery and wound fully healed. Withhold ≥28 days before elective surgery. Discontinue for wound dehiscence or necrotising fasciitis. - CBC with DifferentialPer chemotherapy schedule
RoutineIncreased neutropenia with combination chemotherapy; monitor for signs of MAHA (schistocytes, elevated LDH, low haptoglobin) if concurrent anti-VEGF agent. - Haemorrhage SymptomsEach cycle
Trigger-basedAssess for epistaxis, haemoptysis, GI bleeding, vaginal bleeding, CNS haemorrhage. Withhold for recent haemoptysis ≥2.5 mL. Discontinue for Grade 3–4 haemorrhage. - Variceal Assessment (HCC only)Within 6 months before starting
RoutineEGD recommended to evaluate for varices before initiating bevacizumab + atezolizumab in HCC patients. Patients with variceal bleeding within 6 months were excluded from trials. - Pregnancy StatusBefore treatment initiation
RoutineMay cause fetal harm. Effective contraception required during treatment and for 6 months after last dose. Counsel about ovarian failure risk (34% vs. 2%).
Contraindications & Cautions for Bevacizumab
Absolute Contraindications
- Squamous cell NSCLC — fatal pulmonary haemorrhage rate of 31% in clinical trials; bevacizumab is only approved for non-squamous histology.
- Recent haemoptysis ≥2.5 mL (half teaspoon) of red blood — FDA PI explicitly prohibits use.
- Active serious haemorrhage — bevacizumab exacerbates bleeding; contraindicated with ongoing Grade 3–4 haemorrhage.
Relative Contraindications (Specialist Input Recommended)
- Planned major surgery within 28 days — increased wound healing complications (15% vs. 4%); must be withheld pre-operatively and not restarted until full wound healing.
- Recent major surgery (<28 days) or unhealed surgical wound — do not initiate until wound is fully healed.
- Known ovarian cancer with recto-sigmoid involvement or clinical bowel obstruction — highest GI perforation risk.
- Significant pre-existing cardiovascular disease (recent MI, unstable angina) — increased ATE risk, particularly in patients >65 years with history of arterial thromboembolism.
- Pregnancy — teratogenic in animal studies; effective contraception required during and 6 months after treatment.
Use with Caution
- Elderly patients (≥65 years) — increased risk of Grade 3–5 ATE and Grade 3–4 proteinuria.
- Pre-existing hypertension — bevacizumab worsens hypertension; ensure adequate BP control before initiating.
- Patients with diabetes — increased ATE risk in combination with other risk factors.
- HCC with high variceal bleeding risk — patients with variceal bleeding within 6 months, untreated or incompletely treated varices, or high bleeding risk were excluded from trials.
FDA Class-Wide Safety Advisory
VEGF Pathway Inhibitors: Vascular Toxicity Profile
All VEGF-targeted agents share a class-wide risk profile including hypertension, proteinuria, haemorrhage, arterial and venous thromboembolism, wound healing complications, and GI perforation. These risks are mechanistically linked to VEGF pathway inhibition and apply to bevacizumab and all biosimilar products. Note: the bevacizumab boxed warning was removed in June 2019, but the serious adverse event profile remains unchanged and requires vigilant monitoring.
Patient Counselling for Bevacizumab
Purpose of Therapy
Bevacizumab works by blocking a protein (VEGF) that tumours need to build new blood vessels. By cutting off the tumour’s blood supply, it helps chemotherapy work more effectively. It is given as a drip (IV infusion) alongside other cancer treatments and continues for as long as the cancer responds and side effects remain manageable.
How to Receive Treatment
Infusions are given every 2 or 3 weeks depending on the cancer type. The first infusion takes about 90 minutes, and if tolerated, subsequent ones can be shortened to 30 minutes. Regular blood pressure checks and urine tests are needed throughout treatment. No dose reductions are used; if serious side effects occur, the drug is withheld or stopped entirely.
High Blood Pressure
Tell patientBlood pressure will be checked regularly. Many patients develop high blood pressure during treatment, which is usually manageable with medication. Home blood pressure monitoring may be recommended.
Call prescriberFor severe headache, visual disturbances, confusion, or chest pain — these may indicate dangerously high blood pressure or a rare neurological complication (PRES).
Bleeding Risk
Tell patientNosebleeds are very common and usually mild. However, bevacizumab can increase the risk of more serious bleeding. Report any unusual bruising, blood in stool or urine, coughing up blood, or heavy menstrual bleeding.
Call prescriberImmediately for any coughing up of blood, blood in vomit, black tarry stools, sudden severe headache, or any signs of heavy or uncontrolled bleeding.
Abdominal Symptoms (GI Perforation Risk)
Tell patientA rare but serious side effect is a small tear in the bowel wall. Any new or worsening abdominal pain, especially with fever, nausea, or vomiting, needs urgent evaluation.
Call prescriberUrgently for sudden severe abdominal pain, fever with abdominal symptoms, or inability to pass gas or stool — these may indicate a surgical emergency.
Surgery & Wound Healing
Tell patientBevacizumab slows wound healing. Inform all healthcare providers (including dentists) that you are taking this medication before any planned procedures. Treatment must be stopped at least 28 days before surgery.
Call prescriberIf any wound shows signs of infection, delayed healing, opening, or unusual discharge.
Fertility & Pregnancy
Tell patientBevacizumab can harm an unborn baby and may affect fertility in women of childbearing age, with a significant risk of ovarian failure. Use effective contraception during treatment and for 6 months after the last dose. Discuss fertility preservation options before starting treatment.
Call prescriberImmediately if pregnancy is suspected or confirmed during treatment or within 6 months of the last dose.
Sources
Regulatory (PI / SmPC)
- Avastin (bevacizumab) injection. Full Prescribing Information. Genentech, Inc. Revised May 2020. FDA LabelPrimary source for all dosing, warnings, adverse reactions, pharmacokinetics, and drug interaction data in this monograph.
- FDA Approval History for Bevacizumab (Avastin). Initial U.S. Approval: February 2004. FDA InformationRegulatory history including the 2004 approval for mCRC and subsequent approvals across multiple tumour types.
Key Clinical Trials
- Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335-2342. doi:10.1056/NEJMoa032691Pivotal AVF2107g trial establishing bevacizumab + IFL as first-line mCRC standard, demonstrating median OS improvement of 4.7 months.
- Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355(24):2542-2550. doi:10.1056/NEJMoa061884E4599 trial establishing bevacizumab + carboplatin/paclitaxel as first-line non-squamous NSCLC standard, showing median OS of 12.3 vs. 10.3 months.
- Tewari KS, Sill MW, Penson RT, et al. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (GOG 240). Lancet. 2017;390(10103):1654-1663. doi:10.1016/S0140-6736(17)31607-0GOG-0240 trial demonstrating OS benefit of bevacizumab in cervical cancer (16.8 vs. 13.3 months).
- Burger RA, Brady MF, Bookman MA, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011;365(26):2473-2483. doi:10.1056/NEJMoa1104390GOG-0218 trial evaluating bevacizumab in frontline ovarian cancer, establishing the bevacizumab-throughout strategy with PFS benefit.
- Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020;382(20):1894-1905. doi:10.1056/NEJMoa1915745IMbrave150 trial establishing atezolizumab + bevacizumab as first-line HCC standard, demonstrating significant OS and PFS improvement over sorafenib.
- Bennouna J, Sastre J, Arnold D, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14(1):29-37. doi:10.1016/S1470-2045(12)70477-1TML study supporting bevacizumab continuation beyond first progression in mCRC with a switch in chemotherapy backbone.
Guidelines
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Colon Cancer. Version 1.2025. NCCNCurrent NCCN colon cancer guidelines incorporating bevacizumab in first-line and second-line mCRC.
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 3.2025. NCCNNCCN NSCLC guidelines specifying bevacizumab eligibility criteria including non-squamous histology requirement.
Pharmacokinetics / Special Populations
- Lu JF, Bruno R, Eppler S, et al. Clinical pharmacokinetics of bevacizumab in patients with solid tumors. Cancer Chemother Pharmacol. 2008;62(5):779-786. doi:10.1007/s00280-007-0664-8Population PK analysis of 491 patients establishing CL of 0.207 L/day, Vd 2.39 L, and t½ ~20 days.
- Han K, Peyret T, Marchand M, et al. Population pharmacokinetics of bevacizumab in cancer patients with external validation. Cancer Chemother Pharmacol. 2016;78(2):341-351. doi:10.1007/s00280-016-3079-6Updated population PK model from 1792 patients confirming CL ~9 mL/h, V1 2.88 L, and t½ 19.6 days for a 70-kg patient.
Mechanistic / Basic Science
- Ferrara N, Hillan KJ, Gerber HP, Novotny W. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004;3(5):391-400. doi:10.1038/nrd1381Review of bevacizumab development from bench to clinic, including mechanism of VEGF-mediated angiogenesis and tumour vessel normalisation.