From the Guidelines
Bevacizumab should be withheld for at least 6 weeks prior to a liver biopsy. This recommendation is based on the most recent and highest quality study, which suggests that bevacizumab's anti-angiogenic effects can increase the risk of bleeding and impair wound healing 1. The study found that stopping bevacizumab at least 6 weeks before elective surgery can minimize the risk of bleeding and wound complications.
Key Considerations
- Bevacizumab's mechanism of action as an anti-angiogenic agent that inhibits vascular endothelial growth factor (VEGF) increases bleeding risk and impairs wound healing.
- The drug has a relatively long half-life of approximately 20 days, which means its effects persist well after administration.
- For patients undergoing liver biopsies, this increased bleeding risk is particularly concerning given the vascularity of the liver.
- After the biopsy, bevacizumab therapy should generally not be resumed until adequate healing has occurred, typically 4 weeks post-procedure.
Clinical Implications
- The exact timing for holding and resuming bevacizumab should be determined on a case-by-case basis, considering factors such as the patient's underlying condition, urgency of the biopsy, and the specific treatment protocol.
- Patients should be monitored closely for signs of bleeding following the procedure, especially if bevacizumab was administered within the recommended holding period.
- The risk of bleeding and wound complications can be minimized by stopping bevacizumab at least 6 weeks before the liver biopsy, as supported by the study 1.
From the FDA Drug Label
Withhold for at least 28 days prior to elective surgery.
- Bevacizumab should be withheld prior to liver biopsy if it is considered an elective surgery.
- The recommended withholding period is at least 28 days. 2
From the Research
Bevacizumab and Liver Biopsy
- The decision to withhold bevacizumab prior to liver biopsy depends on various factors, including the patient's overall health, the reason for the biopsy, and the potential risks and benefits of continuing or discontinuing bevacizumab therapy.
- Studies have shown that bevacizumab can be safely administered until 5 weeks before liver resection in patients with metastatic colorectal cancer without increasing the rate of surgical or wound healing complications or severity of bleeding 3, 4.
- Bevacizumab has been shown to persistently inactivate VEGF at the time of surgery despite preoperative cessation, suggesting that it may not be necessary to withhold bevacizumab prior to liver biopsy 4.
- However, other studies suggest that bevacizumab may impair wound healing and increase the risk of bleeding, and recommend withholding bevacizumab for at least 6-8 weeks before elective surgery or invasive procedures 5, 6.
Recommendations for Bevacizumab Use Prior to Invasive Procedures
- A delay of at least 5 weeks between the last injection of bevacizumab and invasive surgery is recommended 6.
- A delay of 4 weeks between surgery and the initiation of bevacizumab treatment is also recommended 6.
- Referral to a medico-surgical team experienced in the management of patients receiving bevacizumab is strongly recommended 6.