{"entity":{"id":"bevacizumab","kind":"drug","name":"Bevacizumab","aka":[],"tldr":"Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.","summary":"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.","status":"approved","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Bevacizumab","links":[{"label":"FDA label","url":"https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125085s340lbl.pdf"},{"label":"NICE TA1136: bevacizumab (originator and biosimilars) with fluoropyrimidine-based chemotherapy for metastatic colorectal cancer","url":"https://www.nice.org.uk/guidance/ta1136"},{"label":"NICE TA212 (2010, not recommended)","url":"https://www.nice.org.uk/guidance/ta212"},{"label":"EMA Avastin","url":"https://www.ema.europa.eu/en/medicines/human/EPAR/avastin"}],"tags":[],"related":["bevacizumab-glioma"],"cancers":["colorectal","ovarian","nsclc","rcc","hcc","cervical","glioblastoma"],"sections":[],"technologies":["monoclonal-antibody","antiangiogenic","angiogenesis-models"],"targets":["vegf"],"drugs":[],"companies":["roche-genentech","hetero"],"institutions":[],"pathways":["vegf-angiogenesis"],"terms":[],"trials":["sunlight","paradigm","nct04854668","nct05445778","nct07221357","nct07775287","nct07216703","nct07318558","nct06824467","nct03390686","nct05654454","nct06921785","nct04547166","nct06819007","nct03847428","nct06123884","nct07722494","nct06497985","nct05904886","nct07225270","nct07564141","nct04712643","nct07676162","nct07527858","nct06445062","nct05775159","nct06512051","nct07024784","nct07446322","nct06107413","nct07054567","nct06792695","nct07805551","nct07479485","nct07079631","nct06820463","nct06948448","nct06679985","nct06873763","nct07071714","nct04068610","nct05739981","nct05919264","nct05797168","nct07714668","nct05440708","nct07042802","nct07244705","nct04938583","nct06427941","nct06096779","nct07474727","nct06607458","nct06890338","nct06840002","nct06859775","nct05733598","nct06843447","nct06040099","nct06493760","nct05824975","nct06558227","nct05489211","nct04931342","nct02519348","nct04524871","nct07059845","nct06496971","nct06465563","nct03899155","nct06276283","nct06061809","nct05405595","nct06783647","nct06951503","nct06771622","nct04262466","nct06895928","nct06730750","nct03148418","nct05867420","nct04121455","nct07297212","nct02671435","nct05584670","nct05112965","nct02734004","nct07448922","nct05101070","nct06750094","nct06906341","nct07111546","nct06271837","nct06016062","mountaineer","nct06697197","nct07283367","nct04626635","nct05239741","nct06703177","nct07286266","nct06796907","gog-0218-icon7","paola-1","keynote-b96","avf2107g","cairo3","cairo5","tribe","tribe2"],"people":["judah-folkman"],"bottlenecks":[],"keyPapers":["paper-hurwitz-bevacizumab-crc-nejm-2004"],"journals":[],"dependsOn":[],"notes":["In gynaecological oncology bevacizumab is used in first-line and recurrent ovarian cancer (GOG-0218, ICON7, OCEANS, AURELIA), as the partner for olaparib maintenance in HRD-positive disease (PAOLA-1), and in first-line cervical cancer regimens with pembrolizumab (KEYNOTE-826) or atezolizumab (BEATcc); it is given at 15 mg/kg every 3 weeks with chemotherapy and continued as maintenance. In the GOG-0218 concurrent and maintenance arm hypertension affected 42 percent (17 percent grade 3 or higher) and bowel perforation 2.6 percent."],"brand":"Avastin (and biosimilars)","modality":"Monoclonal antibody (anti-VEGF)","mechanism":"Neutralises circulating VEGF-A, reducing angiogenesis and normalising tumour vasculature.","approvals":[{"region":"US","year":2004,"indication":"First-line metastatic colorectal cancer with 5-FU chemotherapy"},{"region":"US","year":2006,"indication":"NSCLC; later ovarian, cervical, RCC, glioblastoma, HCC"},{"region":"US","year":2023,"indication":"Refractory mCRC with trifluridine/tipiracil (SUNLIGHT)"},{"region":"US","year":2014,"indication":"Platinum-resistant ovarian cancer with chemotherapy; recurrent/metastatic cervical cancer with chemotherapy"},{"region":"US","year":2018,"indication":"First-line stage III-IV ovarian cancer after surgery"},{"region":"US","year":2020,"indication":"First-line maintenance with olaparib in HRD-positive ovarian cancer"},{"region":"EU","year":2005,"indication":"Metastatic colorectal cancer with fluoropyrimidine-based chemotherapy","note":"Avastin marketing authorisation issued 12 January 2005."},{"region":"England (NICE)","year":2026,"indication":"First- and second-line metastatic colorectal cancer with fluoropyrimidine-based chemotherapy, only when targeted treatment or immunotherapy is unsuitable","note":"TA1136, published 25 February 2026, covers the originator and biosimilars and requires an agreed price within the Medicines Procurement and Supply Chain. The earlier first-line appraisals TA212 (2010) and TA118 (2007) did not recommend it."}],"mechanismSteps":["Bevacizumab binds VEGF-A in the blood and tumour","VEGF-A can no longer reach VEGFR2 on blood-vessel cells","New vessel growth slows and existing tumour vessels become less leaky","Chemotherapy penetrates better and the tumour is starved"],"dosing":{"route":"Intravenous","schedule":"5-10 mg/kg every 2 weeks (mCRC); 15 mg/kg every 3 weeks in other tumours","modifications":"Hold 28 days around surgery; stop for GI perforation or severe haemorrhage","monitoring":"Blood pressure, urine protein","source":"https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125085s340lbl.pdf"},"toxicity":[{"event":"Hypertension","note":"Common; manageable"},{"event":"Proteinuria"},{"event":"GI perforation","note":"Rare, boxed warning"},{"event":"Bleeding","note":"Epistaxis common; serious haemorrhage rare"},{"event":"Impaired wound healing","note":"Boxed warning"}],"access":[],"regulatoryEvents":[{"date":"2004-02","type":"approval","region":"US","note":"First anti-angiogenic approval (AVF2107)"},{"date":"2008-02-22","type":"accelerated-approval","region":"US","note":"Accelerated approval on a surrogate endpoint, with a confirmatory trial required.","indication":"In combination with paclitaxel for patients who have not received chemotherapy for metastatic HER2 negative breast cancer"},{"date":"2009-05-05","type":"accelerated-approval","region":"US","note":"Accelerated approval on a surrogate endpoint, with a confirmatory trial required.","indication":"Progressive glioblastoma following prior therapy"},{"date":"2011-11-18","type":"withdrawal","region":"US","note":"Withdrawn: the indication came off the label 3.7 years after its accelerated approval.","indication":"In combination with paclitaxel for patients who have not received chemotherapy for metastatic HER2 negative breast cancer"},{"date":"2014-08-14","type":"approval","region":"US","note":"Cervical cancer with chemotherapy (GOG-0240)"},{"date":"2017-09","type":"approval","region":"US","note":"First biosimilar (bevacizumab-awwb) approved"},{"date":"2017-12-05","type":"conversion","region":"US","note":"Confirmed: the accelerated approval of 2009 converted to traditional approval 8.6 years after it was granted.","indication":"Progressive glioblastoma following prior therapy"},{"date":"2018-06-13","type":"approval","region":"US","note":"First-line ovarian cancer (GOG-0218)"},{"date":"2020-05-08","type":"approval","region":"US","note":"With olaparib as HRD-positive maintenance (PAOLA-1)"},{"date":"2023-08","type":"label-change","region":"US","note":"With trifluridine/tipiracil in refractory mCRC"}]},"route":"/drugs/bevacizumab/","neighbours":{"drug":[{"id":"bevacizumab-glioma","kind":"drug","name":"Bevacizumab (glioblastoma 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