Medical Oncologist
Bevacizumab (Avastin)
Bevacizumab Myths: — What Avastin Actually Does
You may have been told that bevacizumab 'starves the tumour.' That is a reasonable shorthand — but it can lead to significant misunderstandings about what this drug actually does and what to expect from it. This page works through the most common beliefs about bevacizumab and what the evidence shows.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Not chemotherapy — Bevacizumab is a targeted biologic, not a cytotoxic drug. Its side effects are different from chemotherapy, and hair loss is not expected.
- Does not dissolve tumours — It reduces the blood supply tumours rely on to grow. It does not directly attack or break down cancer cells.
- Response is read on scans — Feeling no different is normal. Imaging tells your team whether it is working — not how you feel from day to day.
- Aims to control, not cure — The goal of bevacizumab in most situations is to slow or interrupt cancer growth, not to eliminate it.
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Bevacizumab does not dissolve or directly kill cancer cells. It works by blocking a protein called VEGF that tumours use to build new blood vessels. Without that blood supply, the tumour's ability to grow is limited. It is a targeted biologic, not chemotherapy, and it aims to control cancer rather than cure it.
Which common beliefs about bevacizumab are wrong?
Bevacizumab dissolves or shrinks the tumour directly
Bevacizumab does not touch tumour cells. It blocks VEGF, the protein tumours use to recruit new blood vessels, so the tumour's ability to sustain growth is reduced — but nothing is dissolved or broken down by the drug itself. The belief comes from how oncologists explain the mechanism: 'starving the tumour' sounds as though something is disappearing, when the effect is actually about interrupting growth.
It is a form of chemotherapy
Bevacizumab is a monoclonal antibody — a biologic that targets one specific protein — not a cytotoxic drug designed to kill rapidly dividing cells. This distinction matters because the side effects are different. Hair loss and bone marrow suppression are not characteristic of bevacizumab. People assume it is chemotherapy because it is given by intravenous infusion in the same day-care oncology setting.
Bevacizumab will cure my cancer
The goal of bevacizumab in most situations is to slow growth and extend the time before the cancer progresses — not to eliminate it. NCCN and ASCO guidance describes its role in terms of progression-free survival, not cure. The expectation of cure comes partly from how treatment responses are described in the media, where any meaningful result tends to be framed in absolute terms.
If it is working, I will feel it working
You may feel no different while bevacizumab is working, and no different while it is not. It acts on blood vessels, not on symptoms directly. Response is assessed by imaging — CT or PET-CT scans at intervals set by your oncologist — not by how you feel day to day. Feeling well does not mean the drug is failing, and feeling unwell does not mean it is succeeding.
The side effects are the same as chemotherapy
Bevacizumab has its own distinct side effect profile. It is associated with high blood pressure, protein in the urine, a small risk of wound-healing problems, and a rare but serious risk of gut perforation — none of which are typical chemotherapy effects. People often assume otherwise because both are given by infusion in oncology settings. When bevacizumab is combined with chemotherapy, both sets of effects can occur, so the assumption is not always entirely wrong — but the source matters for reporting symptoms accurately.
How does bevacizumab actually work?
Tumours cannot grow beyond a small size without building their own network of blood vessels. To do that, they release a protein called VEGF — vascular endothelial growth factor — that signals nearby vessels to sprout new branches toward the tumour.
Bevacizumab is a monoclonal antibody that binds to VEGF and blocks that signal. Without new blood vessels, the tumour's ability to sustain growth and spread is reduced.
It does not enter cancer cells, and it does not break them down. Its effect is on the tumour's environment — specifically, on the vessels the tumour depends on.
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What does this mean for your treatment?
Your oncologist will tell you whether response is being measured by tumour size on CT, by metabolic activity on a PET scan, or by another marker. That measurement — not how you feel — is what guides treatment decisions.
Bevacizumab is given as a day-care infusion at intervals specified by your treatment plan. Most people go home the same day.
Because it affects blood vessels throughout the body, your team will monitor your blood pressure and kidney function regularly. Report any new symptoms — especially headache, chest pain, or unusual bleeding — promptly rather than waiting for your next scheduled visit.
What do these medical terms mean?
- VEGF
- Vascular endothelial growth factor — a protein that tumours release to stimulate new blood vessel growth toward themselves. Bevacizumab works by blocking this protein.
- Angiogenesis
- The process by which new blood vessels form from existing ones. Tumours use this process to build their own blood supply. Anti-angiogenic drugs interfere with it.
- Monoclonal antibody
- A protein made in a laboratory to recognise and bind to one specific target — in bevacizumab's case, VEGF. It is a biologic, not a small-molecule chemical drug, and is given by infusion rather than taken as a tablet.
- Progression-free survival
- The length of time during and after treatment that cancer does not grow or spread. This is one of the outcomes oncologists use to measure whether a treatment is helping, and it is different from cure.
- Day care infusion
- An intravenous treatment given in a clinic setting where you go home on the same day. Bevacizumab is administered this way — it does not require an overnight hospital stay.
Did you know?
The principle behind bevacizumab — that blocking a tumour's blood supply can interrupt its growth — was first described in peer-reviewed scientific literature in the early 1970s. It took several decades of research before a drug built on this mechanism reached patients in routine cancer care.
That gap between idea and approved treatment is typical of oncology drug development, and it is part of why the evidence base for bevacizumab is now extensive across multiple cancer types.
Source: American Society of Clinical Oncology (ASCO)
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Common questions
Frequently asked questions
Does bevacizumab cause hair loss?
Bevacizumab on its own does not typically cause hair loss. It works on blood vessels, not on rapidly dividing cells the way chemotherapy does, so scalp follicles are not targeted. If you are receiving bevacizumab alongside chemotherapy, hair loss may happen — but that effect comes from the chemotherapy component, not the bevacizumab. If you are on bevacizumab alone and noticing hair thinning, tell your team, because other causes are worth investigating.
How will my doctor know if bevacizumab is working?
Your team will use scans — usually CT, and sometimes PET-CT coordinated with a partner imaging centre — taken at set intervals during treatment to assess response. How you feel day to day is not a reliable indicator, because bevacizumab works on blood vessels rather than directly on symptoms. A response on imaging may mean the tumour has shrunk, stayed the same size, or shown reduced metabolic activity, depending on what your oncologist is measuring for your cancer type.
Why is bevacizumab given alongside chemotherapy?
The two approaches work differently and can complement each other. Chemotherapy targets dividing cells directly; bevacizumab cuts the blood supply the tumour uses to sustain itself and grow. NCCN and ASCO guidance for several cancer types recommends the combination because evidence shows better outcomes with both together than with either alone in those settings. Your oncologist will explain whether the combination applies to your specific cancer type and stage.
Can I have bevacizumab if I already have high blood pressure?
High blood pressure is a known side effect of bevacizumab, so existing hypertension is something your team will manage carefully — it is not an automatic reason to rule out the drug. Your oncologist will weigh the clinical benefit against the added risk for your situation. Tell your team about any blood pressure medication you are already taking, and make sure readings are checked regularly during treatment. A significant rise while on bevacizumab is a reason to contact your team promptly rather than waiting for your next visit.
Does bevacizumab work for all cancers?
No. Bevacizumab is indicated for specific cancer types and stages, as defined in guidance from bodies including NCCN and ESMO. It is used in certain colorectal, lung, ovarian, cervical, and kidney cancers, and in glioblastoma, among others — but that list does not cover most cancers. Being told it is not suitable for your situation is a clinical decision based on where the evidence supports its use, not a comment on the severity of your condition.