Bevacizumab (anti-VEGF)
Monoclonal antibody targeting VEGF — blocks VEGF-mediated vascular permeability
- Response rate
- Ambiguous — VEGF drops but clinical benefit inconsistent; deaths reported
- Onset
- VEGF decreases rapidly; clinical response unreliable
- Route
- IV infusion
- Line
- Not recommended
- IgM effect
- N/A
Evidence summary
Despite lowering VEGF levels, bevacizumab has produced disappointing clinical results. In a series of 6 patients (Kanai et al. 2013), 4 had no response and 2 died. In the broader literature, 6 of 17 patients died without showing response. Failure likely because multiple cytokines (IL-6, IL-12, TNF-alpha) drive disease beyond VEGF alone. Sudden VEGF removal may also cause collapse of fragile new vessels, worsening capillary leak. Not recommended as monotherapy; possible bridge to definitive treatment.