What is bevacizumab (Avastin®)?

Bevacizumab (Avastin®) is a targeted therapy drug used to treat different types of cancer.    

It is best to read this information with our general information about the type of cancer you have.

Bevacizumab belongs to a group of targeted therapy drugs known as monoclonal antibodies. It is also an angiogenesis inhibitor. 

Bevacizumab targets a protein called vascular endothelial growth factor (VEGF) that helps cancer cells grow a new blood supply. Targeting VEGF reduces the supply of oxygen and nutrients so that the tumour shrinks or stops growing.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How bevacizumab is given

You will be given bevacizumab at a day unit as an outpatient. Bevacizumab can be given on its own or in combination with other cancer drugs. 

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have treatment. 

You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready. 

The drug is given as a drip into a vein (intravenous infusion). Bevacizumab can be given through: 

  • a short thin tube the nurse puts into a vein in your arm or hand (cannula)
  • a fine tube that goes under the skin of your chest and into a vein close by (central line)
  • a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).

You have the first treatment slowly over 90 minutes. If you do not have any problems, you have the next treatment over 60 minutes. After this, you usually have it over 30 minutes.

Your course of treatment

You usually have a course of several cycles of treatment over a few months. Bevacizumab is usually given once every 2 or 3 weeks, depending on the type of cancer you have.

Your nurse, pharmacist or doctor will discuss your treatment plan with you.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Side effects while treatment is being given

Some people may have side effects while they are being given the treatment or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed
  • shivering
  • itching
  • a skin rash
  • feeling dizzy
  • a headache
  • feeling breathless or wheezy
  • swelling of your face or mouth
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:

  • pale skin
  • lack of energy
  • feeling breathless
  • feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Bleeding

Bevacizumab can sometimes cause bleeding problems, such as:

  • nosebleeds
  • bleeding gums
  • blood spots or rashes on the skin.

Tell your doctor if you are taking any medicines that may affect bleeding.

Contact your doctor straight away if you have any unusual bleeding. This includes:

  • vomiting or coughing up blood
  • unexpected vaginal bleeding
  • blood in your poo (stools).

High blood pressure

Bevacizumab can increase your blood pressure. A nurse will check your blood pressure regularly during your treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.

Feeling sick

You may feel sick in the first few days after treatment. If you feel sick, tell your doctor. They can prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Tummy (abdominal) pain

Some people have pain or discomfort in their tummy. Let your doctor know if this happens to you.

Bevacizumab may cause a hole (perforation) in the bowel. This is more likely if you have also had radiotherapy to the pelvis (lower part of the tummy).  Contact your doctor immediately if you have severe pain in the tummy and sickness and vomiting. It is also very important to let them know if:

  • you have bleeding from the back passage or black stools
  • you are vomiting up blood
  • your vomit looks like coffee grounds.
 

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Feeling tired

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.

If you feel sleepy, do not drive or use machinery.

Headaches

This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals. If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Effects on the kidneys

Bevacizumab can sometimes affect the kidneys. You will have urine and blood tests to check how well your kidneys are working.  If urine tests show a lot of protein in your urine you may need other tests to check your kidneys.

Muscle or joint pain

You may get pain in your muscles or joints with this treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Skin changes

Bevacizumab may affect your skin. Your skin may become, dry and itchy and red.  Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Some people may notice a slight change in skin colour . Any changes to your skin are usually temporary and improve when treatment finishes.

Sore and red palms of hands and soles of feet

You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

  • keep your hands and feet cool
  • moisturise your hands and feet regularly
  • avoid tight-fitting socks, shoes and gloves.

Eye problems

Your eyes may become watery. Your doctor can prescribe eye drops to help with this. Always tell your doctor or nurse if you notice any changes in your vision.

Voice changes

You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.

Changes in the way your heart works

This is rare. It is most likely to affect people who have heart disease or who have had radiation to the chest or some types of chemotherapy drugs.

Tell your doctor straight away if:

  • you feel that your heart is beating too fast
  • you have chest pain or difficulty breathing
  • you have ankle swelling.

These could be signs that bevacizumab is affecting your heart.

Less common side effects

Blood clots

Bevacizumab can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm 
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot can increase the risk of having a stroke. Signs of a stroke include:

  • weakness or numbness in one side of your body 
  • slurred speech or drooping of your face, mouth or eye.

If you, or someone you know, notices you have any of these symptoms, contact a doctor straight away.

Slow wound healing

Wounds may take longer to heal while you are being treated with bevacizumab. If you have any wounds which are not healing or look infected, speak to your doctor straight away.

If you have surgery planned, bevacizumab will be stopped about four weeks before it. You can start it again when the wound is fully healed.

Blockage in the bowel

Bevacizumab can sometimes cause your bowel to become blocked (bowel obstruction). Tell your doctor straight away if you stop passing poo and have severe pain in your tummy.

Fistula

Very rarely, bevacizumab can cause a fistula. A fistula is an abnormal opening that connects two or more parts of the body. If this happens, it is more likely in the part of the body affected by the cancer.

Jaw problems (osteonecrosis)

Rarely, bevacizumab may cause osteonecrosis of the jaw. This is when bone tissue in the jaw becomes damaged and dies. Symptoms of osteonecrosis include:

  • pain
  • swelling
  • redness of the gums
  • loose teeth.

Tell your cancer specialist and dentist straight away if you have any of these symptoms.

Other information

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.