Bevacizumab: more fatal adverse effects

Bevacizumab, a cytotoxic monoclonal antibody targeting vascular endothelial growth factor, is used to treat various malignancies. At best, it has only a moderate impact on overall survival, at a cost of serious adverse effects. The main adverse effects of bevacizumab are arterial hypertension, arterial and venous thrombosis, cardiovascular events, and bleeding. Two meta-analyses of clinical trials published in 2011 showed that fatal adverse events were more frequent with bevacizumab than with other cytotoxic agents or placebo. In one of these studies, bevacizumab increased the risk of fatal adverse effects by a factor of 3.5 in patients also receiving a taxane or platinum salt. In the other study, bevacizumab increased the rate of fatal adverse effects by a factor of about 1.8. Four meta-analyses have shown statistically significant increases in the risk of arterial hypertension, haemorrhage, febrile neutropenia, heart failure, thrombosis and gastrointestinal tract perforation in patients receiving bevacizumab. In practice, before deciding to combine bevacizumab with other cytotoxic drugs, the expected benefits for the individual patient should be weighed against this excess of adverse effects.