Bevacizumab is a recombinant humanized monoclonal IgG1 antibody that selectively binds to and neutralizes the biological activity of human vascular endothelial growth factor (VEGF). By inhibiting VEGF, it prevents its interaction with VEGF receptors (Flt-1 and KDR) on the surface of endothelial cells, thereby inhibiting tumor angiogenesis, a critical process for tumor growth and metastasis. In the Indian context, it is a cornerstone of biologic therapy for various advanced cancers, used predominantly in tertiary care oncology centers.
Adult: Dose is weight-based or fixed. Common regimens: 5 mg/kg, 7.5 mg/kg, or 15 mg/kg body weight, administered intravenously every 2 or 3 weeks. The 400mg vial is often used as part of a fixed-dose regimen or for patients weighing approximately 80 kg at the 5 mg/kg dose. Exact dose is calculated per protocol.
Note: For intravenous infusion ONLY. NEVER administer as an IV push or bolus. The first infusion should be administered over 90 minutes. If tolerated, the second infusion may be over 60 minutes, and subsequent infusions over 30 minutes. Dilute prescribed dose in 100 mL of 0.9% Sodium Chloride Injection, USP. Do not administer or mix with dextrose solutions. Use within 8 hours of preparation. Use a 0.2 micron in-line filter. Monitor vital signs during and after infusion.
Bevacizumab is a humanized monoclonal antibody that binds with high affinity to all biologically active isoforms of human Vascular Endothelial Growth Factor-A (VEGF-A). This binding prevents VEGF-A from interacting with its cell surface receptors, VEGFR-1 (Flt-1) and VEGFR-2 (KDR/Flk-1), on endothelial cells.
Pregnancy: Category X. Bevacizumab is contraindicated. Based on animal studies and its mechanism, it can cause fetal harm, including impaired organogenesis and reduced fetal weight. Effective contraception is required during and for at least 6 months after the last dose.
Driving: May cause fatigue, dizziness, headache, and syncope (due to hypertension). Patients should be cautioned about driving or operating machinery until they know how bevacizumab affects them.
| Sunitinib, Sorafenib (other VEGF pathway inhibitors) | Increased risk of microangiopathic hemolytic anemia (MAHA). Avoid concomitant use. | Major |
| Anthracyclines (e.g., Doxorubicin) | Potential increased risk of cardiotoxicity (congestive heart failure). Monitor cardiac function closely. | Major |
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen, Diclofenac | Increased risk of gastrointestinal perforation and impaired wound healing. Use with extreme caution. | Major |
| Anticoagulants (Warfarin, DOACs) and Antiplatelets (Aspirin, Clopidogrel) | Increased risk of severe or fatal hemorrhage. Monitor coagulation parameters closely. | Major |
| Immunosuppressants | Potential additive immunosuppression, increasing risk of infections. | Moderate |
Same composition (Bevacizumab (400mg)), different brands: