Bevacizumab

Antineoplastic monoclonal antibodies
Antineoplastic monoclonal antibodies
High alert
An error with this medicine can cause serious harm: double checks and protocols are used.
Pregnancy: contraindicated
Can harm the fetus and may cause ovarian failure; pregnancy and breastfeeding are avoided during treatment and for months after.

An antibody that traps VEGF and starves tumours of new blood vessels; used in colorectal, lung, ovarian and cervical cancer. Watch blood pressure and bleeding.

Updated Nov 1, 2026

Also called: anti-VEGF antibody

Quick facts

Group: Antineoplastic monoclonal antibodies
Target: Vascular endothelial growth factor A (VEGF-A)
Used for: Metastatic colorectal cancer · Ovarian cancer
Key effects: High blood pressure · Protein in the urine
Monitor: Blood pressure at every visit · Urine protein
ATC: L01FG01

No doses: the clinician sets them by the current guideline.

Mechanism of action

Vascular endothelial growth factor A (VEGF-A)Bevacizumab

The structure shows VEGF held by the Fab arms of a slightly mutated bevacizumab; the antibody covers the surface VEGF uses to bind its receptors.

Target in 3D: Vascular endothelial growth factor A (VEGF-A). PDB structure 6BFT (RCSB PDB, public domain). View the structure at RCSB PDB

Bevacizumab is a humanised IgG1 antibody that binds circulating VEGF-A. VEGF can then no longer reach its receptors (VEGFR1 and VEGFR2) on endothelial cells, so the signal for new vessel growth and leaky vessels is lost. Tumours that need new vessels grow more slowly, and it is usually combined with chemotherapy.

Binds circulating VEGF-A
VEGF cannot reach its endothelial receptors
Less new vessel growth and leakiness
Tumour growth slows (often with chemotherapy)

Indications

Metastatic colorectal cancer, with fluoropyrimidine-based chemotherapy. Colorectal cancer →
Non-squamous non-small cell lung cancer, with chemotherapy. Lung cancer →
Ovarian cancer, with chemotherapy. Ovarian cancer →
Cervical cancer, with chemotherapy. Cervical cancer →
Advanced kidney cancer (renal cell carcinoma). Renal cell carcinoma →
Glioblastoma after earlier treatment.
Unresectable hepatocellular carcinoma, together with atezolizumab. Hepatocellular carcinoma →
Sometimes injected into the eye for wet age-related macular degeneration. Age-related macular degeneration →

Adverse effects

Common

High blood pressure
Protein in the urine
Nosebleeds
Mouth sores, taste change, diarrhoea
Muscle and joint pain

Contraindications

Recent major surgery or an unhealed wound
Recent coughing up of blood (haemoptysis)
Active serious bleeding or a bleeding disorder
Pregnancy

Key interactions

Other drugs against the VEGF pathway (e.g. VEGFR kinase inhibitors): Share and add the same vascular toxicities: hypertension, bleeding, clots and perforation.
Planned surgery (including dental surgery): Bevacizumab is stopped weeks before and restarted only after the wound has healed.

What is monitored

Blood pressure at every visit
Urine protein
Signs of bleeding, abdominal pain (perforation) and clots
Wound healing
Neurological symptoms (headache, vision change, seizures)

Administration and safety

Intravenous infusion only, never as a push or bolus; the first infusion runs slower and the patient is watched for an infusion reaction.
Not given within weeks before or after major surgery, or before a wound has healed.
Look-alike names: bevacizumab is checked against other -mab antibodies by full name before giving it.
Intravitreal use for eye disease is a different preparation and route, prepared separately.

Pregnancy and breastfeeding

Can harm the fetus and may cause ovarian failure; pregnancy and breastfeeding are avoided during treatment and for months after.

Nursing care

Check blood pressure before each infusion and know the plan if it is high.
Dipstick or lab test of the urine for protein as ordered.
Watch for chills, flushing, chest pain or breathlessness during the infusion.
Teach the patient to report black stools, vomiting blood, severe belly pain, sudden headache or weakness of one side.
Remind the patient to tell any surgeon or dentist about the treatment.

Pharmacokinetics

Absorption: Intravenous infusion.
Distribution: Stays mainly in the blood and extracellular fluid, like other IgG antibodies.
Elimination: Broken down like natural IgG; not cleared by the kidney or liver enzymes.
Half-life: About 20 days, which is why surgery is planned weeks after the last dose.

Test yourself

Think of the answer, then tap the question to see it.

What does bevacizumab bind?

Circulating VEGF-A, the growth factor, not its receptor.

Why is bevacizumab stopped weeks before elective surgery?

Because it impairs wound healing and has a long half-life.

Which two simple checks are made at every bevacizumab visit?

Blood pressure and urine protein.

A patient on bevacizumab for colon cancer develops sudden severe abdominal pain and fever. What must be suspected?

Gastrointestinal perforation.

Add to my cards (4)

Connections

← Back to the class: Antineoplastic monoclonal antibodies

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Bevacizumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.