Bevacizumab
The first drug to starve tumours of blood vessels. Approved in 2004 for bowel cancer, it remains a standard partner for chemotherapy in many cancers and is the add-on that makes late-line pills work better.
Humanised anti-VEGF-A IgG1. Standard with first- and second-line chemotherapy in mCRC (all RAS statuses, right-sided tumours), with trifluridine/tipiracil in refractory disease (SUNLIGHT), and in ovarian, cervical, NSCLC, RCC, HCC (with atezolizumab), and glioblastoma. Biosimilars since 2017 have cut its cost sharply. Hypertension, proteinuria, bleeding, wound-healing delay, and rare GI perforation.
1.Bevacizumab binds VEGF-A in the blood and tumour
- Route
- Intravenous
- Schedule
- 5-10 mg/kg every 2 weeks (mCRC); 15 mg/kg every 3 weeks in other tumours
- Dose modifications
- Hold 28 days around surgery; stop for GI perforation or severe haemorrhage
- Monitoring
- Blood pressure, urine protein
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2022/125085s340lbl.pdf. Doses are for orientation; the current label governs.
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9035 for Avastin; biosimilars (Mvasi, Zirabev, Alymsys, Vegzelma, Avzivi) have their own codes and lower patient coinsurance.
- Commercial insurance
- step therapy common
Commercial plans almost universally prefer a bevacizumab biosimilar over Avastin; prior authorisation checks indication.
- Assistance programmes
- Genentech Access Solutions
- Genentech Patient Foundation — Free medicine for eligible patients regardless of insurance type.
- PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B) · FDA: Biosimilars. Not medical or financial advice; verify with your plan.
- Appraised for
- Metastatic colorectal cancer with oxaliplatin or fluorouracil-based chemotherapy
- Notes
- NICE has never recommended bevacizumab for colorectal (TA118, TA212), ovarian (TA284, TA285), breast (TA214) or cervical cancer. It was widely funded by the pre-2016 Cancer Drugs Fund and later removed. Biosimilars (from 2020) have cut the price; some indications are funded via local policies. Bevacizumab with atezolizumab for HCC is funded under TA666.
- NHS England
- Not routinely funded
Sources: NICE TA212. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
- Feb 2004ApprovalUS
First anti-angiogenic approval (AVF2107)
- 26 Feb 2004ApprovalUS
First anti-angiogenic approval (colorectal)
- 14 Aug 2014ApprovalUS
Cervical cancer with chemotherapy (GOG-0240)
- Sept 2017ApprovalUS
First biosimilar (bevacizumab-awwb) approved
- 13 Jun 2018ApprovalUS
First-line ovarian cancer (GOG-0218)
- 8 May 2020ApprovalUS
With olaparib as HRD-positive maintenance (PAOLA-1)
- Aug 2023Label changeUS
With trifluridine/tipiracil in refractory mCRC
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2004 | First-line metastatic colorectal cancer with 5-FU chemotherapy |
| US | 2006 | NSCLC; later ovarian, cervical, RCC, glioblastoma, HCC |
| US | 2023 | Refractory mCRC with trifluridine/tipiracil (SUNLIGHT) |
| US | 2004 | Metastatic colorectal cancer (first) |
| US | 2014 | Platinum-resistant ovarian cancer with chemotherapy; recurrent/metastatic cervical cancer with chemotherapy |
| US | 2018 | First-line stage III-IV ovarian cancer after surgery |
| US | 2020 | First-line maintenance with olaparib in HRD-positive ovarian cancer |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Hypertension Common; manageable | — | — |
| Proteinuria | — | — |
| GI perforation Rare, boxed warning | — | — |
| Bleeding Epistaxis common; serious haemorrhage rare | — | — |
| Impaired wound healing Boxed warning | — | — |
| Hypertension GOG-0218 concurrent + maintenance arm | 42% | 17% |
| Gastrointestinal perforation | — | 2.6% |
| Proteinuria ≥ grade 3 | — | 1.6% |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topRecruiting now (live from ClinicalTrials.gov)
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials in OnCo
Latest papers
topQuery for this drug: (TITLE:"Bevacizumab" OR ABSTRACT:"Bevacizumab" OR TITLE:"Avastin" OR ABSTRACT:"Avastin" OR TITLE:"and biosimilars" OR ABSTRACT:"and biosimilars") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Bevacizumab, not a curated reading list.
Pages like this
not linked directly; found by shared links- ProductCisplatin
Shares BEATcc / ENGOT-Cx10 / GOG-3030, KEYNOTE-826, COMPASSION-16 / AK104-303, Vulvar cancer.
- ProductRamucirumab
Shares VEGF angiogenesis, The angiogenic switch & tumour vessels, Anti-angiogenic therapy, VEGF / VEGFR.
- TermHallmark: inducing or accessing vasculature
Shares Judah Folkman, VEGF angiogenesis, The angiogenic switch & tumour vessels, Anti-angiogenic therapy.
- ProductLenvatinib
Shares Use imaging to find the window when tumour blood vessels are working properly, Anti-VEGF class toxicities (hypertension, proteinuria, bleeding, perforation), VEGF angiogenesis, The angiogenic switch & tumour vessels.
- PairingPD-1 blockade + VEGF inhibition
Shares Use imaging to find the window when tumour blood vessels are working properly, VEGF angiogenesis, Anti-angiogenic therapy, Renal cell carcinoma.
- TechnologyCancer-associated thrombosis prevention and treatment
Shares Venous thromboembolism (VTE), Intravasation & circulating tumour cells, Anti-angiogenic therapy, Glioma & glioblastoma.
- ProductRegorafenib
Shares Anti-VEGF class toxicities (hypertension, proteinuria, bleeding, perforation), The angiogenic switch & tumour vessels, Anti-angiogenic therapy, VEGF / VEGFR.
- InstitutionARCAGY-GINECO
Shares GOG-0218 & ICON7 (bevacizumab), PAOLA-1 / ENGOT-ov25, Anti-angiogenic therapy, Cervical cancer.