MVASI

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MVASI (MVASI).

How it works

Monoclonal antibody that inhibits vascular endothelial growth factor (VEGF), preventing binding to VEGFR-1 and VEGFR-2, thereby inhibiting angiogenesis and tumor growth.

What the body does with it

Metabolism	Metabolized via proteolytic degradation into small peptides and amino acids; no cytochrome P450 involvement.
Excretion	Primarily metabolized via reticuloendothelial system; no significant renal or biliary excretion of intact drug.
Half-life	Approximately 20 days (range 11–50 days); typical dosing interval every 2–3 weeks.
Protein binding	Bound to VEGF and other plasma proteins; specific % not well-characterized, estimated low.
Volume of Distribution	Approximately 3.3 L (not weight-based; central volume ~2.1 L, peripheral ~1.2 L).
Bioavailability	IV only (100%); not administered via other routes due to protein nature.
Onset of Action	IV: weeks to months for clinical effect (e.g., tumor response); exact time varies by indication.
Duration of Action	Sustained for weeks due to long half-life; continuous suppression of VEGF until drug levels decline.

Classification & Brands

Dosing & administration

5 mg/kg intravenously every 2 weeks for metastatic colorectal cancer; 15 mg/kg intravenously every 3 weeks for non-small cell lung cancer, glioblastoma, renal cell carcinoma, and cervical cancer.

Dosage form	INJECTABLE
Renal impairment	No dose adjustment required for GFR ≥15 mL/min. Safety and efficacy not established in patients with GFR <15 mL/min or on dialysis.
Liver impairment	No dose adjustment required for Child-Pugh A or B. Safety and efficacy not established in Child-Pugh C.
Pediatric use	Not approved for pediatric use; safety and efficacy not established.
Geriatric use	No specific dose adjustment, but increased risk of arterial thromboembolic events, hypertension, and proteinuria; monitor closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MVASI (MVASI).

Breastfeeding	No human data on bevacizumab in breast milk; M/P ratio unknown. Bevacizumab is a large protein likely excreted in low amounts, but due to risk of neonatal adverse effects (e.g., impaired wound healing, bleeding), discontinue breastfeeding or drug based on importance.
Teratogenic Risk	Bevacizumab (MVASI) is a VEGF inhibitor. Human data suggest risk of fetal malformations (e.g., cleft palate, cardiac defects) and spontaneous abortions. First trimester: High risk of teratogenicity; contraindicated. Second and third trimesters: Risk of oligohydramnios, renal impairment, and fetal growth restriction. Avoid use in pregnancy.

Warnings & precautions

■ FDA Black Box Warning

Gastrointestinal perforations, surgery and wound healing complications, hemorrhage.

Side Effect Profile

Serious Effects

Absolute Contraindications

Known hypersensitivity to bevacizumab or any excipient; recent major surgery (within 28 days); active bleeding (e.g., hemoptysis, gastrointestinal bleeding).

Clinical Precautions

Precautions

Gastrointestinal perforation, fistula formation, hemorrhage, arterial thromboembolic events, venous thromboembolic events, hypertension, posterior reversible encephalopathy syndrome (PRES), proteinuria, infusion-related reactions, impaired wound healing, reversible posterior leukoencephalopathy syndrome (RPLS), congestive heart failure, and necrotizing fasciitis.

Clinical Tips & Counseling

Drug interactions

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MVASI

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MVASI (MVASI).

How it works

Monoclonal antibody that inhibits vascular endothelial growth factor (VEGF), preventing binding to VEGFR-1 and VEGFR-2, thereby inhibiting angiogenesis and tumor growth.

What the body does with it

Metabolism	Metabolized via proteolytic degradation into small peptides and amino acids; no cytochrome P450 involvement.
Excretion	Primarily metabolized via reticuloendothelial system; no significant renal or biliary excretion of intact drug.
Half-life	Approximately 20 days (range 11–50 days); typical dosing interval every 2–3 weeks.
Protein binding	Bound to VEGF and other plasma proteins; specific % not well-characterized, estimated low.
Volume of Distribution	Approximately 3.3 L (not weight-based; central volume ~2.1 L, peripheral ~1.2 L).
Bioavailability	IV only (100%); not administered via other routes due to protein nature.
Onset of Action	IV: weeks to months for clinical effect (e.g., tumor response); exact time varies by indication.
Duration of Action	Sustained for weeks due to long half-life; continuous suppression of VEGF until drug levels decline.

Classification & Brands

Dosing & administration

5 mg/kg intravenously every 2 weeks for metastatic colorectal cancer; 15 mg/kg intravenously every 3 weeks for non-small cell lung cancer, glioblastoma, renal cell carcinoma, and cervical cancer.

Dosage form	INJECTABLE
Renal impairment	No dose adjustment required for GFR ≥15 mL/min. Safety and efficacy not established in patients with GFR <15 mL/min or on dialysis.
Liver impairment	No dose adjustment required for Child-Pugh A or B. Safety and efficacy not established in Child-Pugh C.
Pediatric use	Not approved for pediatric use; safety and efficacy not established.
Geriatric use	No specific dose adjustment, but increased risk of arterial thromboembolic events, hypertension, and proteinuria; monitor closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MVASI (MVASI).

Breastfeeding	No human data on bevacizumab in breast milk; M/P ratio unknown. Bevacizumab is a large protein likely excreted in low amounts, but due to risk of neonatal adverse effects (e.g., impaired wound healing, bleeding), discontinue breastfeeding or drug based on importance.
Teratogenic Risk	Bevacizumab (MVASI) is a VEGF inhibitor. Human data suggest risk of fetal malformations (e.g., cleft palate, cardiac defects) and spontaneous abortions. First trimester: High risk of teratogenicity; contraindicated. Second and third trimesters: Risk of oligohydramnios, renal impairment, and fetal growth restriction. Avoid use in pregnancy.

Warnings & precautions

■ FDA Black Box Warning

Gastrointestinal perforations, surgery and wound healing complications, hemorrhage.

Side Effect Profile

Serious Effects

Absolute Contraindications

Known hypersensitivity to bevacizumab or any excipient; recent major surgery (within 28 days); active bleeding (e.g., hemoptysis, gastrointestinal bleeding).