Bevacizumab is a type of drug called a monoclonal antibody. These drugs are sometimes called targeted therapies. They work by ‘targeting’ specific proteins (receptors) on the surface of cells.

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.

Bevacizumab may be given if a cancer has spread to other parts of the body. It may be given with chemotherapy for:

• bowel cancer
• lung cancer
• ovarian cancer, fallopian tube cancer and peritoneal cancer
• breast cancer
• cervical cancer.

It can also be given with interferon for kidney cancer.

Bevacizumab may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial.

If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment is not available.

A nurse will give you bevacizumab as a drip into a vein (intravenous infusion). It is usually given once every two or three weeks, depending on the type of cancer you have.

You have the first treatment slowly over 90 minutes. If you don’t have any problems, you can have the next treatment over 60 minutes. After this, you can usually have it over 30 minutes.

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.

Side effects during infusion

Some people may have a reaction to bevacizumab. This is rare and if it happens it is usually mild. A reaction is more likely with the first or second infusion so you have these more slowly.

Your nurse will closely monitor you while you are having the infusion. Tell your nurse or doctor if you feel unwell or have any of the following:

• fever, chills or dizziness
• a rash
• swollen lips, tongue or throat
• feeling breathless or wheezy
• pain in the chest, back or stomach.

A reaction can usually be treated by stopping the drip until you feel better. Rarely, a reaction can happen a few hours after treatment. If you have these symptoms or feel unwell after you get home, contact the hospital straight away for advice.

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.

Effects on blood cells

This treatment can reduce the number of blood cells in your blood. You will have regular blood tests to check your blood cell levels. If the number of white blood cells, or blood-clotting cells (platelets), gets too low, your doctor may delay your treatment until the levels improve.

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 called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.

Symptoms of an infection include:

• feeling shaky
• a sore throat
• a cough
• diarrhoea
• needing to pass urine a lot.

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

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

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

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor or nurse if you have any bruising or bleeding that you can’t explain. This includes:

• nosebleeds
• bleeding gums
• tiny red or purple spots on the skin that may look like a rash.

Increased blood pressure

This treatment can cause high blood pressure. You will have your blood pressure checked regularly. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.

If you have high blood pressure before you start treatment, your doctor will monitor you closely during treatment.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Feeling tired

Feeling tired is a common side effect. 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 operate machinery.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. 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.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Sore mouth and ulcers

Your mouth may become sore or dry and you may get small ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might advise you to use mouthwashes. It is important to follow any advice you are given and to drink plenty of fluids.

Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce soreness.

Loss of appetite

This treatment can affect your appetite. Do not worry if you don’t 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.

Changes in how your kidneys work

Bevacizumab can sometimes affect the kidneys. You may have urine and blood tests to check that your kidneys are working well.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect 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.

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.

Blood clots

This treatment can increase the chances of a blood clot. A clot can cause:

• pain, redness and swelling in a leg or arm
• breathlessness
• chest pain.

Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

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 any surgery planned, bevacizumab will be stopped about four weeks before the operation and not started again until the wound is fully healed.

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. If you have chest pain, difficulty breathing or ankle swelling, let your doctor know. These could be signs that bevacizumab is affecting your heart.

Pain in the tummy (abdomen)

Bevacizumab can cause a hole (perforation) in the bowel but this is not common. It is more likely if you have also had radiotherapy to the pelvis (lower part of the tummy). Tell your doctor straight away if you have sudden or severe pain in your tummy (abdomen).

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 can include pain, swelling, redness of the gums and loose teeth. Tell your cancer specialist and dentist straight away if you have any of these symptoms.

Gum disease, problems with your dentures and some dental treatments, such as having a tooth removed, can increase the risk of this. Before you start taking the drug, you will be advised to have a full dental check-up.

It is important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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 this treatment.