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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.
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.
Backbone ribbon from PDB 1BJ1. RCSB PDB 1BJ1. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Neutralises circulating VEGF-A, reducing angiogenesis and normalising tumour vasculature. Connects to VEGF / VEGFR.
1.Bevacizumab binds VEGF-A in the blood and tumour
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2022/125085s340lbl.pdf. Doses are for orientation; the current label governs.
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 plans almost universally prefer a bevacizumab biosimilar over Avastin; prior authorisation checks indication.
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.
Sources: NICE TA1136. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
First anti-angiogenic approval (AVF2107)
In combination with paclitaxel for patients who have not received chemotherapy for metastatic HER2 negative breast cancer
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
Progressive glioblastoma following prior therapy
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
In combination with paclitaxel for patients who have not received chemotherapy for metastatic HER2 negative breast cancer
Withdrawn: the indication came off the label 3.7 years after its accelerated approval.
Cervical cancer with chemotherapy (GOG-0240)
First biosimilar (bevacizumab-awwb) approved
Progressive glioblastoma following prior therapy
Confirmed: the accelerated approval of 2009 converted to traditional approval 8.6 years after it was granted.
First-line ovarian cancer (GOG-0218)
With olaparib as HRD-positive maintenance (PAOLA-1)
With trifluridine/tipiracil in refractory mCRC
| 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 | 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 |
| EU | 2005 | Metastatic colorectal cancer with fluoropyrimidine-based chemotherapy · Avastin marketing authorisation issued 12 January 2005. |
| England (NICE) | 2026 | First- and second-line metastatic colorectal cancer with fluoropyrimidine-based chemotherapy, only when targeted treatment or immunotherapy is unsuitable · 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. |
| Adverse event |
|---|
| Hypertension Common; manageable |
| Proteinuria |
| GI perforation Rare, boxed warning |
| Bleeding Epistaxis common; serious haemorrhage rare |
| Impaired wound healing Boxed warning |
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.
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Chemoembolisation combined with durvalumab and bevacizumab is a new option for intermediate-stage hepatocellular carcinoma where approved, though overall survival benefit is not yet shown.
Adjuvant immunotherapy is not standard after curative treatment of hepatocellular carcinoma; surveillance, antiviral therapy and risk factor control remain the approach.
Trifluridine-tipiracil with bevacizumab is the refractory-line standard, and a reminder that combining two drugs already on the shelf can beat anything new in the same line.
Immunotherapy combinations, largely extrapolated from pleural trials, now have direct supporting data in peritoneal mesothelioma and are used after or instead of chemotherapy in unresectable disease.
It is the strongest evidence that the consensus subtypes could choose between the two first-line biologicals, and the clearest statement of why they have not: it is a retrospective analysis of a subset of one trial, on an assay nobody has validated for clinical use.
The negative counterweight to FIRE-3. The two trials are reconciled only by primary tumour side, which is why the sidedness analysis rather than either trial is what guidelines now cite.
It showed the sidedness effect is not an artefact of pooling and survives adjustment for BRAF, which is what made guideline committees act on it.
The analysis that put 'left-sided, RAS and BRAF wild-type' into every guideline as the anti-EGFR population, and made an anatomical fact into a treatment-selection biomarker.
Query 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.
Shares A Clinical Study of SYS6041 Combination Therapy for Recurrent Ovarian Cancer, A Trial to Compare the Efficacy, Safety, Pharmacokinetics and Immunogenicity of HD204 to Avastin® in Advanced Non-squamous Non-small Cell Lung Cancer , A Study of LBL-024 in Combination With Paclitaxel ± Bevacizumab for the Treatment of Platinum-resistant Ovarian Cancer, Pembrolizumab + Paclitaxel +/- Bevacizumab for Triple-negative Breast Cancer.
Shares Atezolizumab plus bevacizumab in advanced malignant peritoneal mesothelioma, A Study in Participants Previously Enrolled in a Genentech- and/or F. Hoffmann-La Roche Ltd-Sponsored Atezolizumab Study (IMbrella A), A Study of TTI-101 as Monotherapy and in Combination in Participants With Locally Advanced or Metastatic, and Unresectable Hepatocellular Carcinoma, IMbrave050: adjuvant atezolizumab plus bevacizumab versus active surveillance after resection or ablation of high-risk hepatocellular carcinoma.
Shares A Phase 2 Study of SSGJ-707 in Metastatic Colorectal Cancer Patients, A Study of HDM2017 Combination Therapy in Advanced Colorectal Cancer, CAIRO3, Liposomal Irinotecan + Oxaliplatin + Bevacizumab Versus Liposomal Irinotecan + 5-FU/LV.
Shares A Study of Novel Study Interventions and Combinations in Participants With Colorectal Cancer, FOLFIRI and Bevacizumab With or Without Pelareorep for Second-Line Treatment of Metastatic RAS-Mutated, Microsatellite-Stable Colorectal Cancer, A Phase II Study of AMT-676 Combination Therapies in Advanced Colorectal Cancer, A Study to Evaluate the Safety and Efficacy of Pumitamig in Combination With Chemotherapy Versus Bevacizumab in Combination With Chemotherapy in Parti.
Shares A First-in-human, Dose Escalation and Dose Expansion Study of SAR445877 in Adult Participants With Advanced Solid Tumors, A Study of Durvalumab (MEDI4736) and Monalizumab in Solid Tumors, Study of Pembrolizumab (MK-3475) Versus Chemotherapy in Chinese Participants With Stage IV Colorectal Cancer (MK-3475-C66), A Phase II Study of AMT-676 Combination Therapies in Advanced Colorectal Cancer.
Shares A Study of SKB518 as Monotherapy or Combination Therapy in Patients With Advanced Gynecological Malignant Tumors, A Study to Assess Change in Disease Activity and Adverse Events in Adult Participants With Gynecologic Cancers Receiving Intravenous Infusion of IMGN1, A Clinical Study of SYS6041 Combination Therapy for Recurrent Ovarian Cancer, A Clinical Trial of LBL-024 Combination Drug in Patients With Advanced Solid Tumours[Substudy 01(NSCLC)].
Shares A Study of Durvalumab (MEDI4736) and Monalizumab in Solid Tumors, A Study to Evaluate the Safety and Efficacy of Pumitamig in Combination With Chemotherapy Versus Bevacizumab in Combination With Chemotherapy in Parti, COLUMBIA-1: Novel Oncology Therapies in Combination With Chemotherapy and Bevacizumab as First- Line Therapy in MSS-CRC, Study of Onvansertib in Combination With FOLFIRI and Bevacizumab or FOLFOX and Bevacizumab Versus FOLFIRI and Bevacizumab or FOLFOX and Bevacizumab fo.