Bevacizumab is used to treat several cancers by blocking the formation of new blood vessels that tumors need to grow. It is commonly used for metastatic colorectal cancer, non-squamous non-small cell lung cancer, glioblastoma, and metastatic kidney cancer. In gynecologic cancers, it helps treat ovarian, fallopian tube, and primary peritoneal cancers, and is also used for cervical cancer. Additionally, it is combined with atezolizumab for advanced liver cancer.

Tumors require oxygen and nutrients to grow, which they receive through blood vessels. VEGF-A stimulates the formation of these vessels. Bevacizumab binds to VEGF-A, preventing it from activating its receptors on endothelial cells. This inhibition slows the formation of new blood vessels, effectively "cutting off" the tumor’s supply line.

Bevacizumab is administered through an intravenous (IV) infusion. The dosage and frequency depend on the type of cancer being treated and whether it is used alone or with other therapies.

Bevacizumab may cause common side effects like high blood pressure, fatigue, nosebleeds, and mouth sores. Serious side effects can include bleeding, blood clots, poor wound healing, kidney problems, and gastrointestinal perforation. Patients should be closely monitored during treatment.

Bevacizumab is not suitable for all patients and should be used with caution in certain individuals. It is contraindicated in those with uncontrolled high blood pressure, as it may worsen the condition. Caution is also advised in patients who have recently undergone surgery or have open wounds, since the drug can impair wound healing. Individuals with a history of significant bleeding or blood clots (thrombotic events) should also be carefully evaluated before starting treatment. Additionally, bevacizumab is not recommended during pregnancy, as it may cause harm to the developing fetus.

Bevacizumab has emerged as a significant advancement in cancer therapy through its unique mechanism of inhibiting angiogenesis. By targeting VEGF-A, it helps slow tumor growth and improve treatment outcomes in various cancers, including colorectal, lung, brain, kidney, ovarian, and cervical cancers. While it offers meaningful clinical benefits, careful monitoring is essential due to potential side effects. Overall, bevacizumab remains a valuable option in the multidisciplinary approach to cancer treatment.

Tumors may develop resistance to Bevacizumab through alternative angiogenesis pathways, upregulation of other pro-angiogenic factors (like PDGF or FGF), or increased invasiveness and metastasis to bypass VEGF inhibition.

Bevacizumab does not readily cross an intact blood-brain barrier. However, in cases such as glioblastoma where the barrier is disrupted, it can exert its effects locally on tumor-associated vasculature.

Currently, there is no validated predictive biomarker for Bevacizumab response. Research is ongoing on VEGF levels, microvessel density, and circulating endothelial cells as potential markers.

Hypertension is a common on-target side effect due to VEGF inhibition leading to reduced nitric oxide production. It can sometimes correlate with therapeutic efficacy, but uncontrolled hypertension may necessitate dose adjustments or discontinuation.

VEGF is critical for angiogenesis in tissue repair. Bevacizumab impairs new blood vessel formation, delaying wound healing and increasing the risk of dehiscence or surgical complications. A washout period before and after surgery is typically recommended.

Proteinuria, caused by damage to glomerular endothelial cells, can indicate nephrotoxicity. Severe cases may require discontinuation. Monitoring urine protein levels regularly during treatment is crucial.

Reintroduction is case-dependent. If the event was minor and well-managed, Bevacizumab might be resumed cautiously under close monitoring and with anticoagulation, but always based on a risk-benefit assessment.