Bevacizumab (Avastin)

Bevacizumab (pronounced bev-ah-siz-oo-mab) is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. It is also known by its brand name, Avastin. It is a treatment for

• Advanced bowel cancer, given with chemotherapy.
• Advanced non small cell lung cancer, given with chemotherapy
• Kidney cancer
• Advanced ovarian cancer, fallopian tube cancer and peritoneal cancer, given with chemotherapy
• Breast cancer that has spread to other parts of the body

You may also have it as part of clinical trials for other types of cancer.

Bevacizumab targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. All cancers need a blood supply to be able to survive and grow. Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and can't grow. Doctors call treatments that interfere with the development of a blood supply anti angiogenesis treatments.

You have bevacizumab through a drip into a vein. You may have it through a small tube put into the vein (cannula). Or you may have it through a central line, portacath or PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You have the first dose of bevacizumab over 90 minutes. If you don’t have any problems, the infusion time can gradually be reduced to 30 minutes. 

For advanced bowel cancer or breast cancer, you may have bevacizumab every 2 weeks or every 3 weeks. 

For lung cancer or ovarian cancer you usually have it every 3 weeks, and for kidney cancer every 2 weeks.

The side effects associated with bevacizumab are listed below. The effects may be different if you are having it with other drugs. Click on the underlined links for information about coping with the side effects. If there is no link you can go to our cancer drug side effects section for general information or use the search box at the top of the page.

More than 10 in every 100 people have one or more of these.

• High blood pressure occurs during treatment in about 1 in 4 people (25%) – your nurse or doctor will check your blood pressure regularly. Your doctor may start you on blood pressure tablets, increase your dose if you are already on them, or stop bevacizumab until your blood pressure is under control.
• Feeling sick happens in about 2 out of 3 people (67%) but most people aren’t actually sick
• Constipation occurs in up to 4 out of 10 people (40%)
• Diarrhoea and abdominal pain – this can be severe in up to 1 in 3 people treated (32%)
• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal after 6 months to a year
• Pain and weakness affecting your joints, muscles, chest and abdomen
• Numbness or tingling in fingers and toes occurs in more than 1 in 10 people (10%) – this can cause difficulty with fiddly things such as doing up buttons. It may start within a few days or weeks and usually goes within a few months of finishing treatment
• Slow wound healing – you won’t start on bevacizumab until at least 28 days after surgery or after any wounds have healed
• Protein in the urine in about 1 in 4 people (25%) – your nurse will test your urine regularly. If you have protein in your urine you will need to have a 24 hour urine collection to check your kidneys are working normally
• Increased risk of bleeding – your gums may bleed easily and you may have nose bleeds. Tell your doctor as soon as possible if you notice any bleeding or if you suddenly feel unwell or have sudden sharp pain
• This drug may have a harmful effect on a baby developing in the womb – it is not advisable to become pregnant or father a child if you are having this drug and for 6 months after treatment. Talk about contraception with your doctor or nurse before having the treatment
• Poor appetite
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• It is not advisable to breast feed while having treatment with bevacizumab because the drug may come through in the breast milk

Between 1 and 10 in every 100 people have one or more of these.

• A reaction to bevacizumab during infusion affects around 5 in every 100 people (5%), causing chills, a high temperature (fever) and possibly an itchy rash, feeling sick, breathlessness, wheezing, a headache, flushes and faintness
• Drop in white blood cell count causing an increased risk of bacterial infection – infection may cause headaches, aching muscles, a cough, sore throat, pain when passing urine, or may make you feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact your treatment centre if you think you have an infection
• Blood clots – if this happens you will have treatment to thin your blood, dissolve any blood clots, and stop more clots developing
• Heart problems affect fewer than 2 out of 100 people treated (2%), causing chest pain, swollen ankles, breathlessness and a fast heart rate – tell your doctor or nurse if you have any of these symptoms
• A split in the wall of the bowel (bowel perforation) affects fewer than 2 in every 100 people treated (2%) but is a serious side effect if it happens

Fewer than 1 in 100 people have these. If you have any of these symptoms it is important to tell your doctor or nurse.

• Headaches, seizures (fits), changes in eye sight, excessive sleepiness, change in behaviour, possibly high blood pressure – doctors call this group of symptoms Reversible Posterior Leucoencephalopathy Syndrome (RPLS)
• Very high blood pressure (hypertensive encephalopathy) – it can occur with other symptoms such as a headache, feeling sick, sleepiness, and confusion
• Osteonecrosis of the jaw – a few people having bevacizumab have this side effect. Most of the people who have had it were also taking or had recently stopped taking a bisphosphonate. Have a dental check up before you start treatment and tell your dentist that you are having bevacizumab. It is important to clean your teeth regularly

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You will have a contact number for your nurse. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.