Bevacizumab

Targeted agents - monocolonal antibody

• Anti-VEGF (Bevacizumab - avastin)

Colorectal cancer

• Not useful in stage II or III colon cancer
• Can be used in metastatic disease
  • Resectable liver mets
    • Improved pathologic response
  • Palliative metastatic disease
    •  RAS/BRAF mutated tumours or patients who have markers of anti-EGFR resistance, bevacizumab is the preferred medication.

FDA-approved Indications

1. Cervical cancer: Bevacizumab has approval for treating recurrent, persistent, or metastatic cervical cancer in combination with paclitaxel and either cisplatin or topotecan.

2. Metastatic colorectal cancer: Bevacizumab is a first-line or second-line therapy for metastatic colorectal cancer combined with fluorouracil (FU)-based chemotherapy regimens. 

3. Glioblastoma: Bevacizumab has approval as a single agent in patients with progressive glioblastoma following previous therapy.

4. Non-squamous non-small cell lung cancer (NSCLC): Bevacizumab is a first-line treatment combination with carboplatin and paclitaxel for recurrent, locally advanced, unresectable, or metastatic non-squamous non-small cell lung cancer.

5. Ovarian, fallopian tube, or primary peritoneal cancer: Bevacizumab has approved the treatment of platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with a carboplatin chemotherapy regimen or the treatment of platinum-resistant disease in combination with paclitaxel, doxorubicin, or topotecan.

6. Metastatic renal cell carcinoma: Bevacizumab has received approval to treat metastatic renal cell carcinoma in combination with interferon alfa.  

7. Hepatocellular carcinoma (HCC): Bevacizumab, in combination with atezolizumab, is indicated for treating unresectable metastatic hepatocellular carcinoma patients.

   • IMbrave150 Trial
     • Unresectable hepatocellular carcinoma who had not previously received systemic treatment were randomly assigned in a 2:1 ratio to receive either Atezolizumab plus Bevacizumab or Sorafenib
     • Overall survival at 12 months was 67.2% with atezolizumab–bevacizumab and 54.6% with sorafenib