Bevacizumab (Avastin™)

Last Modified: August 21, 2011

Pronounced: BEV-a-SIZ-oo-mab
Classification: Monoclonal Antibody

About Bevacizumab

Bevacizumab is a monoclonal antibody that binds to and inhibits the activity of vascular endothelial growth factor (VEGF). This prevents the VEGF from interacting with its receptor on endothelial cells (lining of blood vessel). This, in turn, inhibits the formation of new blood vessels, which slows down the growth of the particular tissue. In essence, it kills tumors by cutting off their blood supply.

How to Take Bevacizumab

Bevacizumab is given by intravenous (into a vein) infusion. The treatment is delivered over 90 minutes for the first infusion. If that dose is well tolerated, the second infusion can be administered over 60 minutes. If this is well tolerated, subsequent infusions can be given over 30 minutes. Dosage depends on the person and type of cancer being treated.

Bevacizumab is usually given at the same time as other chemotherapy medications. Therefore, this should be kept in mind as the side effects are reviewed.

Possible Side Effects of Bevacizumab

Bevacizumab has the potential to cause several serious side effects. There are some things you can do to manage the more common side effects of Bevacizumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you.

Hemorrhage (Bleeding)

Patients may experience minor bleeding, such as a nosebleed. Serious bleeding has also occurred in patients treated with this medication, including coughing up blood, bleeding into the stomach, vomiting blood, bleeding in the brain (stroke), nosebleeds and vaginal bleeding. People who have had serious bleeding should not take this medication. These events are uncommon, though if they occur, bevacizumab should be discontinued. While a nosebleed may not seem like much of a concern, you should notify your healthcare team right away if you develop bleeding of any sort.

Hypertension (High Blood Pressure)

Patients receiving bevacizumab can develop high blood pressure. Your blood pressure should be monitored at every clinic visit or every 2-3 weeks. If your blood pressure is elevated, you will be treated with a medication to reduce your pressure. If severe hypertension develops, bevacizumab should be discontinued immediately. In both cases, your blood pressure should continue to be monitored, even if bevacizumab is stopped. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.

Gastrointestinal Perforation

Bevacizumab can result in a serious, sometimes fatal, problem called gastrointestinal perforation, which is the development of a hole in the stomach or small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.

Poor Wound Healing

Bevacizumab can lead to slower or incomplete wound healing, such as a surgical wound not healing or staying closed. Therefore, it is recommended that bevacizumab not be given within at least 28 days before or after surgery. In addition, any surgical incision should be fully healed prior to starting bevacizumab. If you notice that your surgical wound has not healed or begins to have signs of infection (redness, swelling, warmth), report this to your healthcare team.

Kidney Damage

Kidney damage can occur while receiving bevacizumab. Your healthcare team will monitor this by periodically checking the amount of protein in your urine. If the protein levels become elevated, you may require further urine tests to evaluate your kidney function. If your kidneys become damaged, you may need to stop receiving this medication.

Additional Rare, But Serious, Side Effects

Stroke or heart problems, including blood clots, heart attack and chest pain, can occur. Bevacizumab should be stopped if these occur. A possible, but rare, side effect is the development of a fistula, which is an abnormal passage between two body parts (for instance, a hole between the lung and esophagus).


Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.