Generic name: Bevacizumab
Brand names: Alymsys, Avastin, Mvasi, Vegzelma, Zirabev
Dosage form: 100 mg/4 mL, 400 mg/16 mL
Drug class: VEGF/VEGFR inhibitors

Medically reviewed by Melisa Puckey, BPharm. Last updated on Dec 6, 2023.

What is bevacizumab?

Bevacizumab injection is a targeted cancer drug used to treat types of colon and rectal cancer, non-small cell lung cancer (NSCLC), glioblastoma, renal cell cancer (RCC), cervical cancer, ovarian cancer, fallopian tube cancer, or peritoneal cancer. Avastin is also used to treat types of hepatocellular carcinoma (HCC).

Bevacizumab belongs to a class of medications called antiangiogenic agents. Bevacizumab works by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.

Avastin was the first brand of bevacizumab to be approved by the FDA on February 26, 2004, and is called the reference product.  Biosimilars of Avastin are Alymsys, Mvasi, Vegzelma and Zirabev.
Bevacizumab is used together with other chemotherapy medications.

Bevacizumab side effects

Common bevacizumab side effects may include increased blood pressure, headache, back pain, dry or watery eyes, dry or flaky skin, stuffy nose, runny nose, sneezing, or altered sense of taste.

Serious bevacizumab side effects 

Get emergency medical help if you have signs of an allergic reaction to bevacizumab, including hives, difficulty breathing, and swelling of your face, lips, tongue, or throat.

Some side effects may occur during the injection. Tell your medical caregiver right away if you feel dizzy, nauseated, light-headed, itchy, sweaty, or have a headache, chest tightness, back pain, trouble breathing, or swelling in your face.

Bevacizumab can cause a serious but rare neurologic disorder that affects the brain. Symptoms may occur within hours of your first dose or may not appear for up to a year after your treatment started. Call your doctor at once if you have extreme weakness or tiredness, headache, confusion, vision problems, fainting, or seizures (blackout or convulsions).

Bevacizumab can cause you to bleed more easily. Call your doctor or seek emergency medical attention if you have:

• easy bruising, unusual bleeding, or any bleeding that will not stop;
• signs of bleeding in your digestive tract - severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; or
• signs of bleeding in the brain - sudden numbness or weakness, slurred speech, severe headache, problems with vision or balance.

Some people taking bevacizumab have developed a perforation (a hole or tear) or a fistula (an abnormal passageway) in the stomach, intestines, throat, lungs, gallbladder, kidney, bladder, or vagina. Call your doctor if you have severe stomach pain or if you feel like you are choking when you eat or drink.

Also call your doctor if you have:

• slow wound healing;
• skin infection or open sores;
• missed menstrual periods;
• kidney problems - swelling, urinating less, feeling tired or short of breath;
• signs of a blood clot - chest pain, sudden cough or shortness of breath, dizziness, coughing up blood, pain, swelling, or warmth in one leg;
• heart problems - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating, swelling, rapid weight gain, feeling short of breath; or
• low white blood cell counts - fever, mouth sores, skin sores, sore throat, cough.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Related/similar drugs

Rybrevant, Opdivo, methotrexate, Keytruda, Avastin, carboplatin, pembrolizumab

Warnings

Bevacizumab can make it easier for you to bleed. Seek emergency medical attention if you have any bleeding that will not stop. You may also have bleeding on the inside of your body.

Call your doctor if you have: signs of bleeding in your digestive tract--feeling very weak or dizzy, severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; or signs of bleeding in the brain--sudden numbness or weakness, slurred speech, severe headache, problems with vision or balance.

Bevacizumab can also cause problems with wound healing, which could result in bleeding or infection. Do not use bevacizumab within 28 days before or after a planned surgery.

Bevacizumab can cause a rare but serious neurologic disorder affecting the brain. Symptoms include headache, confusion, vision problems, feeling very weak or tired, fainting, and seizure (blackout or convulsions). These rare symptoms may occur within hours of your first dose of bevacizumab, or they may not appear for up to a year after your treatment started. Call your doctor at once if you have any of these side effects.

Some people receiving a bevacizumab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your medical caregiver right away if you feel dizzy, nauseated, light-headed, sweaty, itchy, or have a fast heartbeat, chills, wheezing, or chest pain during the injection.

Before taking this medicine

You may not be able to use bevacizumab if you are being treating with other cancer medicines such as doxorubicin, daunorubicin, or if you have or ever had:

• ovarian cancer with symptoms such as severe stomach pain or pelvic pain;
• slow healing of a skin wound or surgical incision;
• surgery within the past 4 weeks (28 days);
• you plan to have surgery within the next 4 weeks (28 days); or
• coughing up blood or vomit that looks like coffee grounds.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• diabetes;
• heart problems such as a heart attack, stroke, blood clot or blood clotting disorder;
• high blood pressure;
• bleeding problems or a perforation (a hole or tear) in your esophagus, stomach, or intestines; or
• kidney disease.

Pregnancy

Bevacizumab may harm an unborn baby. Do not use if you are pregnant. You may need a pregnancy test to make sure you are not pregnant. Use effective birth control while using bevacizumab and for at least 6 months after your last dose. Tell your doctor at once if you become pregnant.

This medicine may cause a woman's ovaries to stop working correctly. Symptoms of ovarian failure include 3 or more missed menstrual periods in a row. It may be harder for you to get pregnant while you are using this medicine and after this treatment. Talk to your doctor about your individual risk.

Breastfeeding

Do not breastfeed while using bevacizumab and for at least 6 months after your last dose.

How is bevacizumab given?

Bevacizumab is given as an infusion into a vein. A healthcare provider will give you this injection.

Tell your caregivers right away if you feel dizzy, nauseated, light-headed, sweaty, or have a headache, shortness of breath, or chest pain during the injection.

Bevacizumab is usually given once every 2 or 3 weeks.

Doses are based on weight. Your dose may change if you gain or lose weight.

You may need frequent medical tests and your cancer treatments may be delayed based on the results.

For detailed bevacizumab dosing information, click the link below.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your bevacizumab injection.

What happens if I overdose?

In a medical setting, an overdose would be treated quickly.

What should I avoid while receiving bevacizumab?

Avoid activities that may increase your risk of bleeding or injury. Use extra care while shaving or brushing your teeth.

What other drugs will affect bevacizumab?

Tell your doctor about all other cancer treatments you are receiving.

Other drugs may interact with bevacizumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

Ingredients and manufacturer

Active ingredient: bevacizumab

Avastin (bevacizumab)
Inactive ingredients: a,a-trehalose dihydrate, polysorbate 20, sodium phosphate dibasic (anhydrous), sodium phosphate monobasic (monohydrate), and Water for Injection, USP.
Manufacturer: Genentech, Inc, 1 DNA Way South San Francisco, CA 94080, USA.

Alymsys (bevacizumab-maly)
inactive ingredients: dibasic sodium phosphate, monobasic sodium phosphate, polysorbate 20, trehalose, and Water for Injection, USP.
Manufacturer: Amneal Pharmaceuticals LLC Bridgewater, NJ 08807 Product of Spain 

Mvasi (bevacizumab-awwb)
Inactive ingredients: α,α-trehalose dihydrate, polysorbate 20, sodium phosphate dibasic, anhydrous, sodium phosphate monobasic, monohydrate, and Water for Injection, USP.
Manufacturer: Amgen, Inc. One Amgen Center Drive Thousand Oaks, CA 91320-1799 

Vegzelma (bevacizumab-adcd)
Inactive ingredients: dibasic sodium phosphate, monobasic sodium phosphate, polysorbate 20, trehalose, and Water for Injection, USP.
Manufacturer: CELLTRION, Inc. 20, Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea. 

Zirabev (bevacizumab-bvzr)
Inactive ingredients: edetate disodium dihydrate, polysorbate 80, succinic acid, sucrose, and Water for Injection, USP. Sodium hydroxide is added to adjust the pH.
Manufacturer: Pfizer Inc. NY, NY 10017.

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Further information

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