Bevacizumab (Avastin), a humanized anti-VEGF monoclonal antibody for cancer treatment (2023)

Biochemical and Biophysical Research Communications

Volume 333 Number 2,

July 29, 2005

, pp. 328-335

Author link opens overlay panel, ,


Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen in vitro and an angiogenesis inducer in vivo. thistyrosine kinaseHigh affinity for Flt-1 (VEGFR-1) and Flk-1/KDR (VEGFR-2)vascular endothelial growth factor receptor. VEGF plays an important role in developmentAngiogenesisIt is also important for reproduction and bone angiogenesis. Substantial evidence also points to VEGF as a mediator of pathological angiogenesis. Anti-VEGF monoclonal antibodies and other VEGF inhibitors block growth of multiple tumor cell linesnude mouse. Clinical trials of VEGF inhibitors in various malignancies are ongoing. Recently, a humanized anti-VEGFMonoclonal antibodies(bevacizumab; Avastin) has been approved by the FDA as a first-line treatment in combination with chemotherapy for metastatic colorectal cancer. In addition, VEGF and intraocularNeovascularizationAssociated with diabetic retinopathy and age-related macular degeneration.

partial fragment

Identification of VEGF

In 1983, Senger et al. [9] reported the partial purification of "vascular permeability factor" (VPF), a protein that induces vascular leakage in the skin, from the conditioned medium of a guinea pig tumor cell line. Because VPF had not been isolated and sequenced, the factor remained molecularly unknown at the time.

In 1989, our laboratory reported the separation and NH2- Terminal sequencing of VEGF, an endothelial cell-specific mitogen, from bovine pituitary cell-conditioned medium [10]. this

VEGF isomers

The human VEGF-A gene consists of eight exons [14], [15]. Alternative exon splicing results in four major VEGF isoforms with 121, 165, 189 and 206 amino acids after cleavage of the signal sequence (VEGF121, vascular endothelial growth factor165, vascular endothelial growth factor189, and vascular endothelial growth factor206) [12]. vascular endothelial growth factor165is the main subtype. A number of less frequent splice variants have also been reported, including VEGF145, vascular endothelial growth factor183vascular endothelial growth factor162, and vascular endothelial growth factor165b(reviewed in [16]).

Alternative splicing regulates bioavailability

vascular endothelial growth factor receptor

There are two VEGF receptor tyrosine kinases (RTKs), Flt-1, also known as VEGFR-1 [27], [28] and KDR, Flk-1 or VEGFR-2 [29], [30], [31].

There is now consensus that VEGFR-2 is a major mediator of the mitogenic, angiogenic, and permeability-enhancing effects of VEGF. For a detailed review of the biology and signaling properties of VEGF receptors, see [16].

In some cases, VEGFR-1 may act as a "decoy" receptor, sequestering VEGF and preventing it from interacting with VEGFR-2

Regulation of VEGF gene expression

Oxygen tension plays an important role in regulating the expression of several genes, including VEGF, and HIF-1 is a key transcriptional regulator in response to hypoxia [40]. A link between the products of the von Hippel–Lindau (VHL) tumor suppressor gene and HIF-1-dependent responses has been established (for review see [41]). The VHL gene is inactivated in patients with von Hippel-Lindau disease, an autosomal dominant neoplastic syndrome characterized by retinal capillary hemangioblastoma

The role of VEGF in tumor angiogenesis

In situ hybridization studies have demonstrated VEGF mRNA expression in many human tumors. These include lung cancer [50], breast cancer [51], gastrointestinal tract [52], kidney cancer [53] and ovarian cancer [54]. However, VEGF expression appears to be variable, not only between different tumor types, but also within the same tumor (for review see [8], [16]). Renal cell carcinomas with particularly high VEGF expression are renal cell carcinomas, consistent with the notion of inactivating VHL mutations

Preclinical studies

In 1997, we reported the humanization of the mouse anti-VEGF monoclonal antibody A.4.6.1. [78]. Like its murine counterpart, bevacizumab binds and neutralizes all human VEGF-A isoforms and bioactive proteolytic fragments, but not mouse or rat VEGF. The binding epitope of bevacizumab has been determined by crystal structure analysis of the complex Fab ligand [79]. The pharmacokinetic properties of bevacizumab in multiple species have been described previously and are consistent with typical humanized mAbs

Ongoing Research and Perspectives

For the first-line treatment of metastatic colorectal cancer, the addition of bevacizumab to bolus IFL chemotherapy resulted in clinically meaningful and statistically significant improvements in all study endpoints, including overall survival, progression-free survival, and response rate. benefits, and profile with acceptable side effects.

Survival improvement with bevacizumab similar or greater than seen in any phase III trial of colorectal cancer treatment


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    What kind of cancer is Avastin used for? ›

    Avastin (chemical name: bevacizumab) is a blood vessel growth inhibitor used off-label to treat certain advanced-stage or metastatic breast cancers. Avastin works by blocking the growth of new blood vessels that cancer cells depend on to grow and function.

    What are the side effects of bevacizumab monoclonal antibodies? ›

    Side effects that you should report to your doctor or health care professional as soon as possible:
    • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue.
    • chest pain or chest tightness.
    • chills.
    • coughing up blood.
    • high fever.
    • seizures.
    • severe constipation.

    What does Avastin do to your body? ›

    Avastin is designed to block a protein called vascular endothelial growth factor, or VEGF. Normal cells make VEGF, but some cancer cells make too much VEGF. Blocking VEGF may prevent the growth of new blood vessels, including normal blood vessels and blood vessels that feed tumors.

    What is the success rate of Avastin? ›

    Results : Of 133 patients, 106 (80%) achieved treatment stability on Avastin. 70 patients (53%) were stable on injections every 8 weeks or longer, and 36 patients (27%) required injections more frequently than every 8 weeks.

    Is Avastin a form of chemo? ›

    No, Avastin is not a chemotherapy drug. But it is an immunotherapy drug. Chemotherapy is a type of treatment that kills cancer cells completely or keeps them from making more cancer cells. Immunotherapy is a treatment that works with your immune system to fight cancer.

    How long can a person stay on Avastin? ›

    You start taking Avastin ® (bevacizumab) with carboplatin and paclitaxel (chemotherapy) to treat your advanced (stage III or IV) ovarian cancer. And you keep taking Avastin as long as your disease is controlled and your side effects are manageable, up to 22 cycles.

    Who should not take bevacizumab? ›

    a patient who is producing milk and breastfeeding. a rupture in the wall of the stomach or intestine. problems with wound healing after a surgery. a type of brain disorder called posterior reversible encephalopathy syndrome.

    Does Avastin affect hair growth? ›

    Avastin isn't known to cause hair loss. This side effect wasn't seen during clinical trials of the drug. Hair loss can be a common side effect of certain chemotherapy drugs. Avastin isn't a chemotherapy drug, but it's often used in combination with chemotherapy to treat various cancers.

    Can monoclonal antibodies cause organ damage? ›

    There is no evidence that any of the anti-SARS-CoV-2 monoclonal antibodies cause serum enzyme elevations or clinically apparent liver injury.

    How will I feel after Avastin infusion? ›

    Examples of mild side effects that have been reported with Avastin include: high blood pressure. minor bleeding, such as nosebleeds or bleeding gums. runny or stuffy nose.

    How fast does Avastin start working? ›

    It starts working immediately but the patient may or may not notice changes in vision over the first week or two. We can see the effects of Avastin on some tests like the Ocular Coherence Tomography (or OCT, a specialized imaging tool) within a few days of treatment.

    What is the controversy with Avastin? ›

    The off-label use of Avastin is controversial because there are anti-VEGF drugs on the market, authorized for AMD, such as Lucentis. Lucentis is however extremely expensive and costs approximately 50 times more than Avastin.

    Does Avastin shrink Tumours? ›

    How Avastin works. Avastin can stop some cancers from developing new blood vessels. This reduces the cancer's supply of oxygen and nutrients, which causes the tumour to shrink, or at least to stop growing.

    What is better than Avastin? ›

    Lucentis is administered in the form of smaller molecules, which is thought to give Lucentis an advantage over Avastin in its ability to penetrate the eye's retina and halt abnormal blood vessel growth contributing to advanced macular degeneration and scarring that causes blindness.

    How much does Avastin typically cost? ›

    Intravenous Solution
    QuantityPer unitPrice
    4 milliliters$212.17$848.68
    16 milliliters$210.39$3,366.21

    Why is Avastin so expensive? ›

    Avastin's cost to patients and insurers can be much higher, though, because doctors and hospitals buy the drug and then sell it to patients or their insurers, often marking up the price. So the $2.3 billion that Genentech recorded in sales of Avastin represents only part of what Americans spent on the drug last year.

    How long does it take to improve after Avastin injection? ›

    Sometimes patients will experience improved vision (better than before the injection) within a week of the procedure. Most will have their vision stabilized.

    What happens after Avastin? ›

    What are the Side Effects or Risks of Avastin Injections? Side effects are generally uncommon and include transient red eye, eye pain, eye floaters, elevated intraocular pressure. More serious side effects are rare and include serious serious eye infections (endophthalmitis) and detached retinas.

    Is Avastin hard on kidneys? ›

    The powerhouse drug Avastin may be linked to severe kidney problems. June 11, 2010 -- Patients taking the anti-cancer drug Avastin may increase their risk of kidney damage, a new study says -- but many doctors say for certain patients, the risk is worth the benefit.

    How many Avastin infusions can you have? ›

    How often do I get Avastin infusions? Avastin infusions are given every 2 or 3 weeks to treat your metastatic colorectal cancer. Because Avastin can be scheduled on the same day you get your IV 5-FU-based chemotherapy, it may not require extra visits to an infusion center.

    Does Avastin cause weight gain? ›

    heart problems--swelling, rapid weight gain, feeling short of breath; low white blood cell counts--fever, mouth sores, skin sores, sore throat, cough, trouble breathing; or. increased blood pressure--severe headache, blurred vision, pounding in your neck or ears.

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    WARNING: GASTROINTESTINAL PERFORATIONS, SURGERY AND WOUND HEALING COMPLICATIONS, and HEMORRHAGE See full prescribing information for complete boxed warning. Metastatic breast cancer, with paclitaxel for treatment of patients who have not received chemotherapy for metastatic HER2-negative breast cancer.

    Is bevacizumab well tolerated? ›

    Overall, bevacizumab is generally well tolerated. Its toxicities are usually nonoverlapping with those of cytotoxic chemotherapy, but may add to the AEs commonly seen with chemotherapy and, again, its vascular normalization properties are postulated to improve the efficacy of cytotoxics.

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    What supplements should I avoid with Avastin? ›

    Mesothelioma patients taking bevacizumab carboplatin, under the brand name Avastin®, should avoid taking concentrated green tea supplements or consuming large amounts of green tea, as it may interfere with cancer drugs. Certain components of green tea could lessen the efficacy of chemotherapy or increase side effects.

    Can you have dental work while on Avastin? ›

    Invasive dental procedures such as tooth extraction or surgery should be avoided if possible, particularly if you are also having treatment with a bisphosphonate. This medicine may affect your ability to get pregnant. It is important to discuss fertility with your doctor before treatment with this medicine is started.

    What is the disadvantage of monoclonal antibodies? ›

    Despite their many advantages, a drawback of monoclonal antibodies is that they are more time-consuming and expensive to produce than polyclonals. If a monoclonal has not yet been developed, researchers may consider using an existing polyclonal antibody, then switching to a monoclonal if one becomes available.

    Why are monoclonal antibodies unethical? ›

    Ethical issues of monoclonal antibodies

    Naturally, this is no different when discussing monoclonal antibodies whose origins can be traced to CHO cells or mouse cells. The use of animals – either as testing subjects or for production purposes – can be deemed unethical by some people.

    How long do monoclonal antibodies stay in your body? ›

    But though these antibodies mimic the infection-fighting work of the immune system, they don't last forever – typically, a monoclonal antibody will stick around for a number of weeks or months.

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    Check with your doctor as soon as possible if any of the following side effects occur: changes in blood or urine tests. high or low blood pressure. high blood sugar (increased appetite, increased thirst, increased urination, weakness)

    How long do you feel bad after chemo infusion? ›

    Nausea and vomiting can start within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, nausea and vomiting may start more than 24 hours after treatment and last several days (called delayed nausea and vomiting).

    Does Avastin cause neuropathy? ›

    If you're having bevacizumab with chemotherapy, you may have numbness or tingling in the hands and feet. This is due to the effect on the nerves and is known as peripheral neuropathy. In most cases it's mild and goes away soon after treatment stops, although in some cases it can be permanent.

    Why was Avastin taken off market? ›

    On November 18, 2011, US FDA Commissioner Margaret Hamburg announced that her agency was revoking breast cancer indication for Avastin (bevacizumab) after concluding that the drug has not been shown to be safe and effective for the treatment of breast cancer.

    Is there an alternative to Avastin? ›

    The FDA approved it back in April 2022. It was launched 6 months later in October 2022. Alymsys was compared to Avastin in another clinical trial of people with advanced NSCLC. People in this study who received Alymsys had a response rate of about 40%.

    Do tumors bleed when they shrink? ›

    Tumor bleed is commonly seen in locally progressive tumors, which have directly infiltrated blood vessels. However, tumor bleed secondary to rapid shrinkage has not been reported previously.

    Can chemo shrink a tumor completely? ›

    It can shrink a primary tumor, kill cancer cells that may have broken off the primary tumor, and stop cancer from spreading. But it doesn't work for everyone. Some types of cancer are more resistant to chemo than others, and others can become resistant to it over time.

    How many patients are treated with Avastin? ›

    Across indications, Avastin has been used to treat more than 2.2 million patients worldwide.

    Can you take Avastin without chemo? ›

    Chemotherapy attacks fast-growing cells, like cancer cells. Avastin ® (bevacizumab) works differently than chemotherapy. Avastin is used with chemotherapy and hits your cancer from another angle. Avastin is a tumor-starving (anti-angiogenic) therapy.

    Is Avastin covered by Medicare? ›

    Average costs for Avastin with Medicare drug coverage

    If your Avastin treatment is covered by Medicare Part B, you will typically be responsible for paying the Part B coinsurance or copayment (20 percent of the Medicare approved amount) after you meet the Part B deductible, which is $233 per year in 2022.

    Are Avastin injections painful? ›

    The injection should therefore be painless. There may be a bit of discomfort when the anaesthetic wears off, but this is usually mild.

    What diagnosis is Avastin approved for? ›

    Avastin is indicated for the treatment of recurrent glioblastoma in adults. Avastin, in combination with carboplatin and paclitaxel, is indicated for the first‑line treatment of patients with unresectable, locally advanced, recurrent or metastatic non–squamous non–small cell lung cancer.

    What conditions does Avastin treat? ›

    Avastin is a drug used to treat wet age-related macular degeneration (AMD). It is also used to treat diabetic eye disease and other problems of the retina. It is injected into the eye to help slow vision loss from these diseases. Avastin is the brand name for the drug, which is called bevacizumab.

    Who should not take Avastin? ›

    Avastin should not be used for 28 days before or after surgery and until surgical wounds are fully healed. Pregnant or think you are pregnant. Data have shown that Avastin may harm your unborn baby. Use birth control while on Avastin.

    How much does an Avastin injection cost? ›

    Intravenous Solution
    QuantityPer unitPrice
    4 milliliters$212.17$848.68
    16 milliliters$210.39$3,366.21

    How quickly does Avastin work? ›

    It starts working immediately but the patient may or may not notice changes in vision over the first week or two. We can see the effects of Avastin on some tests like the Ocular Coherence Tomography (or OCT, a specialized imaging tool) within a few days of treatment.

    Is bevacizumab chemo or immunotherapy? ›

    Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Bevacizumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread.

    Is Avastin a safe drug? ›

    Avastin can sometimes cause serious blood clots that could lead to a heart attack or stroke. If you've had a heart attack or stroke in the past, you may have a higher risk for these side effects. Ask your doctor if Avastin is right for you.

    What is the difference between Avastin and bevacizumab? ›

    But for some types of cancer, Avastin is approved for use on its own. Avastin contains the drug bevacizumab. It's a monoclonal antibody, which is a type of drug that's made from immune system cells. Bevacizumab belongs to a class of medications called vascular endothelial growth factor (VEGF) inhibitors.

    How does Avastin make you feel? ›

    The most common adverse reactions observed in patients receiving Avastin as a single agent or in combination with other anti-cancer therapies at a rate >10% were epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, hemorrhage, lacrimation disorder, back pain, and exfoliative dermatitis.

    Does Avastin affect your teeth? ›

    These are serious side effects. You may need urgent medical attention. Serious side effects are rare. Tell your doctor or dentist if you experience pain in the mouth, teeth and/or jaw, swelling or sores inside the mouth, loosening of a tooth, or numbness or a feeling of heaviness in the jaw.


    1. What happened to Bevacizumab?
    (Professor Sanjiv Kumar Gupta)
    2. How Avastin (Bevacizumab) Treats Metastatic Breast Cancer
    3. VEGF inhibitors in Cancer therapy
    4. Tumors killed by blocking angiogenesis, Rate My Science
    5. Antibody therapy
    6. New Drugs Approved in September 2017
    (Pharma Digest)


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