What Is Bevacizumab (Altuzan, Zirabev)? Which Cancers Is It Used For, and What Are Its Side Effects?
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What is bevacizumab (Altuzan, Zirabev)?
Last updated: October 2026
Bevacizumab is an intravenously administered monoclonal antibody that captures VEGF, the protein that enables tumors to form new blood vessels. It is generally used with chemotherapy or immunotherapy for advanced colorectal, lung, ovarian, cervical, kidney, and liver cancers and glioblastoma. In Türkiye, the original medicine Altuzan and its biosimilars Zirabev, Mvasi, and Bevax are available.
- What it does: It inhibits the formation of new blood vessels that feed the tumor (angiogenesis). In most cancers, it is added to chemotherapy or immunotherapy rather than given alone.
- Where it helps: It prolongs survival or the time without disease progression in metastatic or advanced disease. Benefit has not been demonstrated for postoperative preventive treatment in colon, breast, or lung cancer.
- Reimbursement in Türkiye: With a medical board report, SGK reimburses it for metastatic colorectal cancer, glioblastoma, and cervical cancer, and with atezolizumab for liver cancer.
- Safety: Blood pressure and urine protein are checked before each administration; it is stopped at least 28 days before surgery. Seek medical attention without delay for severe abdominal pain or bleeding.
Why does this matter?
A tumor must establish its own blood vessel network to grow beyond 1-2 millimeters. As the first drug targeting this process to be licensed in 2004, bevacizumab opened the door to a new approach to cancer treatment. Today, it is used in many cancer types; in Türkiye, metastatic colorectal cancer is its broadest licensed and reimbursed use.
The drug's effect differs markedly by cancer type and disease stage: although beneficial in advanced disease, most studies found no benefit in postoperative preventive treatment. Licensed indications also differ between the US, Europe, and Türkiye, and costs have changed substantially with the introduction of biosimilars. Knowing when it is used, what to watch for, and the SGK conditions is important for both safety and access.
What is bevacizumab, and how does it work?
Bevacizumab is a humanized monoclonal antibody that binds to vascular endothelial growth factor (VEGF). By preventing VEGF from binding to receptors on blood vessel walls, it inhibits the tumor's formation of new blood vessels. It is given by intravenous infusion every two or three weeks. Its original name is Avastin; in Türkiye, it is sold as Altuzan and the biosimilars Zirabev, Mvasi, and Bevax.
Oxygen-deprived tumor cells release VEGF. VEGF binds to receptors on the cells of surrounding blood vessel walls, triggering the formation of new, abnormal vessels. Bevacizumab captures VEGF in the circulation and interrupts this signal. One view is that the drug also helps chemotherapy reach the tumor by temporarily "normalizing" its abnormal blood vessels, which is why it is used with chemotherapy in most cancers. Its half-life is about 20 days.
Figure 1 · How does bevacizumab work?
The tumor's signal to form new vessels and the point at which the drug blocks it.
Which cancers is bevacizumab used to treat?
Approved indications differ by country. In Türkiye, the SmPCs include only three cancer types; other uses are possible through TİTCK's off-label approval or list.
| Cancer | US (FDA) | Europe | Turkish SmPC | SGK |
|---|---|---|---|---|
| Metastatic colorectal | Yes | Yes | Yes | Yes |
| Glioblastoma (recurrent) | Yes | No | Yes | Yes |
| Cervical | Yes | Yes | Yes | Yes |
| Liver (with atezolizumab) | Yes | No* | In atezolizumab's licensed indication | Yes |
| Non-small cell lung | Non-squamous | Yes | No | No |
| Ovarian, fallopian tube, peritoneal | Yes | Yes | No | No |
| Kidney (with interferon) | Yes | Yes | No | No |
| Metastatic breast | Withdrawn in 2011 | Yes | No | No |
*In Europe, this combination is included in atezolizumab's product information, not in bevacizumab's list of indications.
Which studies showed benefit?
We discuss bevacizumab with FOLFIRI in colorectal cancer in this article, its use with Lonsurf in later lines in this article; results in cervical cancer in this article, its FDA approval for ovarian cancer in this article, and its role in liver cancer in our article on the ASCO guideline.
Why is it not used for postoperative preventive treatment?
In stage 3 colon cancer, adding bevacizumab did not prolong disease-free survival in the NSABP C-08 and the 2,867-patient AVANT trials; in AVANT, a negative overall survival signal was even seen when it was given with FOLFOX. E5103 and BEATRICE in breast cancer and E1505 in lung cancer also showed no benefit. The US product information explicitly states that it is not used for postoperative treatment of colon cancer. Use in ovarian cancer, starting with postoperative chemotherapy and continuing as maintenance, is a separate setting and delays disease progression.
FDA approval history
| Date | Approval |
|---|---|
| 26 February 2004 | Metastatic colorectal cancer (first anti-VEGF drug); second-line use in 2006 |
| 11 October 2006 | Non-squamous non-small cell lung cancer |
| February 2008 / November 2011 | Accelerated approval for metastatic breast cancer / withdrawal of approval |
| May 2009 | Recurrent glioblastoma (accelerated approval; full approval in December 2017) |
| 2009 | Metastatic kidney cancer (with interferon alfa) |
| August 2014 | Cervical cancer |
| 2014, 2016, 2018 | Ovarian cancer: platinum-resistant, platinum-sensitive, and first-line postoperative treatment |
| 29 May 2020 | Liver cancer (with atezolizumab) |
| 2017-2025 | Biosimilars: Mvasi (2017, first biosimilar in cancer), Zirabev (2019), Alymsys and Vegzelma (2022), Avzivi (2023), Jobevne (2025) |
How is bevacizumab administered?
| Cancer | Dose and interval |
|---|---|
| Colorectal | 5 or 10 mg/kg every two weeks; 7.5 or 15 mg/kg every three weeks are also used in Europe |
| Glioblastoma, kidney | 10 mg/kg every two weeks |
| Lung, cervical, liver | 15 mg/kg every three weeks |
| Ovarian | 15 mg/kg every three weeks or 10 mg/kg every two weeks (depending on the regimen) |
- Infusion time: The first infusion is given over 90 minutes; if well tolerated, the second can be given over 60 minutes and subsequent infusions over 30 minutes. It is administered in a day treatment unit.
- Surgery: It is stopped at least 28 days before planned surgery; after major surgery, it is not started until at least 28 days have passed and the wound has healed.
- Pregnancy and breastfeeding: Effective contraception should be used during treatment and for 6 months after the last dose, and breastfeeding should be avoided during this period. The drug may suppress ovarian function; women considering having children should discuss this before treatment.
What are the side effects of bevacizumab?
According to the US product information, side effects occurring in more than 10% of patients taking bevacizumab are nosebleeds, headache, high blood pressure, runny nose, protein in the urine, altered taste, dry skin, bleeding, increased tearing, back pain, and skin peeling. Hair loss, mouth sores, and low blood counts are mostly due to the accompanying chemotherapy.
| Serious side effect | Frequency | What is done? |
|---|---|---|
| High blood pressure (grade 3-4) | 5–18% | Control with medication; permanently discontinue for a crisis or uncontrolled hypertension |
| Protein in the urine (grade 3-4) | 0.7–7% | Interrupt for at least 2 g in 24 hours; discontinue for nephrotic syndrome |
| Serious bleeding (grade 3-5) | 0.4–7% | Permanently discontinue |
| Arterial clot (heart attack, stroke) | 5% | Permanently discontinue |
| Bowel perforation | 0.3–3% | Permanently discontinue; emergency surgical assessment |
| Delayed wound healing | 15%* | Interrupt until healing |
| Ovarian failure | 34% | Fertility counseling before treatment |
| Brain edema syndrome (PRES) | <0.5% | Permanently discontinue |
*In patients with metastatic colorectal cancer who underwent surgery while receiving bevacizumab. The drug is not used for squamous cell lung cancer because serious lung bleeding was observed in 31% of patients with this subtype.
Figure 2 · Before each administration
Checks during treatment and symptoms requiring emergency care.
The European product information reports loss of jawbone tissue (osteonecrosis), especially in people receiving intravenous bone medicines (bisphosphonates), and recommends a dental examination before treatment. Do not start aspirin, blood thinners, or painkillers on your own; consult your team about bleeding risk. According to the European product information, a serious condition involving the breakdown of blood cells has been reported with sunitinib; in colorectal cancer, bevacizumab is not used with anti-EGFR antibodies (cetuximab or panitumumab).
Are biosimilars as effective as the original medicine?
A biosimilar is a medicine shown to have no clinically meaningful difference from a licensed biological medicine in structure, efficacy, and safety. Bevacizumab is the active ingredient of the first biosimilar approved by the FDA for cancer treatment (Mvasi, September 2017); there are now six bevacizumab biosimilars in the US. In Türkiye, SGK reimburses Zirabev, Mvasi, and Bevax as equivalents to Altuzan under the same conditions. We discuss the concept of biosimilars in our article on biosimilar medicines, and the story of the first approval in this article.
Bevacizumab in Türkiye: licensing, price, and SGK reimbursement
| Product (company) | 100 mg/4 mL | 400 mg/16 mL |
|---|---|---|
| Altuzan (Roche, original) | 7,206.97 TL | 26,536.43 TL |
| Bevax (Abdi İbrahim) | 6,496.08 TL | 24,056.16 TL |
| Zirabev (Pfizer) | 5,058.63 TL | 20,268.54 TL |
| Mvasi (Amgen) | 5,016.56 TL | 19,621.85 TL |
- Licensed indications (SmPC): Metastatic colorectal cancer, glioblastoma after temozolomide, and cervical cancer. Use with atezolizumab for liver cancer is included in atezolizumab's (Tecentriq) licensed indication.
- SGK (SUT 4.2.14.C): Prescribed by specialist physicians in secondary and tertiary hospitals with a medical board report including a medical oncology specialist.
- Colorectal: First-line with 5-FU/folinic acid or FOLFIRI; in second and later lines if not used previously; with oxaliplatin-based first-line regimens in patients who have not received postoperative chemotherapy.
- Glioblastoma: With chemotherapy for recurrence or progression after temozolomide, until progression.
- Cervical: With paclitaxel-cisplatin or paclitaxel-topotecan as first-line treatment for recurrent or metastatic disease unsuitable for local treatment.
- Liver: Under the SUT amendment of 10 July 2025, with atezolizumab for patients who have not received systemic treatment, are Child-Pugh A, and have ECOG 0-1 (a 3-month report).
- Off-label use: TİTCK's oncology list dated 17 March 2023 allows use without additional approval in conditions such as ovarian cancer, endometrial cancer, mesothelioma, some brain tumors, and radiation necrosis. Being on this list does not mean SGK reimbursement.
Example cycle cost (70 kg, single-use vials): 5 mg/kg (350 mg, 1 × 400 mg) costs 26,536 TL with Altuzan and 19,622 TL with Mvasi; 15 mg/kg (1,050 mg, 2 × 400 + 3 × 100 mg) costs 74,694 TL with Altuzan and 54,293 TL with Mvasi.
Prices are retail prices (record dated 31 August 2026) and may change.
Frequently asked questions
- Is bevacizumab chemotherapy?
- No. Bevacizumab is a monoclonal antibody that targets the tumor's blood vessel formation. However, because it is given with chemotherapy or immunotherapy in most cancers, side effects reflect the combined effects of both drugs.
- Does bevacizumab cause hair loss?
- Bevacizumab itself does not cause hair loss. Hair loss during treatment is usually due to the accompanying chemotherapy. The drug's characteristic side effects are high blood pressure, protein in the urine, and nosebleeds.
- Is it safe to use Zirabev or Mvasi instead of Altuzan?
- Yes. Biosimilars are licensed after being shown to have no clinically meaningful difference from the original medicine. In Türkiye, SGK reimburses all three biosimilars under the same conditions as Altuzan; discuss any change of medicine with your oncologist.
- Can I have surgery or a tooth extraction while receiving bevacizumab?
- The drug is interrupted at least 28 days before planned surgery and not restarted until the wound has healed. Consult your oncology team first if a tooth extraction or gum surgery is planned.
Glossary
- Angiogenesis
- The formation of new blood vessels from existing ones.
- VEGF
- Vascular endothelial growth factor; the protein that initiates new vessel formation.
- Biosimilar
- A similar biological medicine shown to have no clinically meaningful difference from a licensed biological medicine.
DROZDOGAN Academy Commentary
As the first treatment targeting blood vessel formation, bevacizumab has been used for more than 20 years. Its benefit is clear when used in the right patient and at the right disease stage.
⚡ Why it matters
It is part of treatments that prolong survival in metastatic colorectal, cervical, and liver cancers. Biosimilars have reduced costs by about a quarter.
✅ Current evidence
In phase 3 trials, overall survival in metastatic disease increased by 2-6 months; with atezolizumab, it has become standard treatment for liver cancer.
⚠️ Limitations
No benefit has been demonstrated for postoperative preventive treatment. There is no biomarker that predicts response. Ovarian and lung cancer are not covered by reimbursement in Türkiye.
🩺 What to do in practice
- At home, monitor your blood pressure.
- Before each cycle, keep up with your urine test.
- Tell your team about planned surgery and dental procedures in advance.
- For severe abdominal pain or bleeding, do not wait.
❓ Open questions
A test to identify who benefits most from bevacizumab, the role of reuse after progression, and which cancers will benefit from combining it with immunotherapy remain under investigation.
Our brief judgment: Bevacizumab is a proven add-on treatment in many advanced cancers; it has no role as preventive treatment in early disease. Biosimilars are equivalent to the original medicine and offer a more economical option.
- This article was prepared in September 2026. Indications, dosing, and side effect information are based on the US (September 2022) and European product information; information for Türkiye is based on the Altuzan, Bevax, and Zirabev SmPCs, the SUT text, and drug price databases.
- Information that could not be verified: Licensing dates in Türkiye (Altuzan and biosimilars); the current content of the bevacizumab entries in TİTCK's off-label list and whether it has been updated since 2023; and the exact dates of the US approvals for second-line colon cancer in 2006 and kidney cancer in 2009.
- Based on general knowledge: The tumor's need for a vessel network to grow beyond a certain size, the vessel "normalization" hypothesis, and practical recommendations concerning aspirin and painkillers.
- The diagrams and Academy commentary are our own. This article is not personal medical advice.
References
- FDA. AVASTIN (bevacizumab) prescribing information, 09/2022. accessdata.fda.gov
- EMA. Avastin: EPAR product information. ema.europa.eu
- Avastin FDA approval history. drugs.com
- FDA approves bevacizumab as frontline ovarian cancer treatment after surgery. OncLive, 2018. onclive.com
- GOG-240 final overall survival. ASCO Post. ascopost.com
- IMbrave150: atezolizumab plus bevacizumab in unresectable HCC. ASCO Post, 2020. ascopost.com
- Cheng AL et al. Updated efficacy and safety data from IMbrave150. J Hepatol. 2022. sciencedirect.com
- André T et al. AVANT: bevacizumab in adjuvant treatment of stage III colon cancer. Ann Oncol. sciencedirect.com
- Allegra CJ et al. NSABP C-08. J Clin Oncol. 2011. doi:10.1200/JCO.2010.30.0855
- BEATRICE final results. Ann Oncol. sciencedirect.com
- Wakelee HA et al. E1505: adjuvant chemotherapy with or without bevacizumab in NSCLC. PMC5789803
- List of biosimilars approved in the US. drugs.com
- Altuzan SmPC. ilacprospektusu.com
- SUT 4.2.14 (via ilacabak). ilacabak.com
- SUT amendment, Official Gazette 10.07.2025, issue 32952. saglikaktuel.com
- TİTCK Oncology Annex to the List of Off-Label Medicines That May Be Used Without Additional Approval, 17.03.2023. teb.org.tr
- Altuzan equivalents and prices. ilacrehberi.com
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