Drugs of interest to pathologists
Drugs related to surgical pathology

Topic Completed: 1 October 2011

Minor changes: 22 August 2019

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PubMed Search: Bevacizumab Avastin [title] review

Him G. Kwee, M.D.
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Page views in 2020 to date: 59
Cite this page: Kwee HG. Bevacizumab. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/drugsbevacizumab.html. Accessed August 3rd, 2020.
Definition / general
  • Monoclonal antibody that inhibits Vascular Endothelial Growth Factor A (VEGF-A) and interferes with angiogenesis
Trade name
  • Avastin®
Clinical information
Approved by U.S. Food and Drug Administration for:
  • Non small cell lung carcinoma that is locally advanced, cannot be removed by surgery, has metastasized or has recurred
  • Colorectal carcinoma that has metastasized
  • Renal cell carcinoma that has metastasized
  • Glioblastoma that is refractory to other treatments
  • Initially approved for patients with metastatic HER2/neu negative breast cancer who have not received chemotherapy; approval revoked on 18 November 2011 (NewYorkTimes.com: F.D.A. Revokes Approval of Avastin for Use as Breast Cancer Drug [Accessed 14 December 2018])
  • Approximate cost: for breast and lung cancer $100,000 per year, for colon cancer $50,000 per year
Uses by pathologists
  • Bevacizumab should only be used if the lung carcinoma is an adenocarcinoma because it can cause severe pulmonary hemorrhage in squamous cell carcinoma
  • Immunohistochemical stains for TTF1, napsinA, CK5 / 6 and p63 may be helpful to distinguish the two carcinomas
  • TTF1 and napsinA are specific for adenocarcinoma and CK5 / 6 is specific for squamous cell carcinoma
  • p63 is sensitive for squamous cell carcinoma but is occasionally positive in adenocarcinoma (Am J Surg Pathol 2011;35:15)

Other reasons for distinguishing lung adenocarcinoma and squamous cell carcinoma:
  • Pemetrexed (Alimta) is only effective for pulmonary adenocarcinoma, not for squamous cell carcinoma
  • Gemcitabine (Gemzar) is effective for squamous cell carcinoma of the lung
  • EGFR mutation analysis is performed only on adenocarcinoma of the lung, not on squamous cell carcinoma and this test may determine the need to use EGFR tyrosine kinase inhibitors such as erlotinib (Tarceva) and gefitinib (Iressa) (J Thorac Oncol 2011;6:1152)
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