Bevacizumab Timing Before Surgery

Critical Timing Requirements

The National Comprehensive Cancer Network recommends that bevacizumab must be discontinued at least 6 weeks before any elective surgery, and this applies to all doses including the 3rd dose 1, 2, 3
The minimum interval between the last bevacizumab dose and elective surgery is 6 weeks, which corresponds to approximately 2 half-lives of bevacizumab (terminal half-life ~20 days) 2, 3, 4, 5
For interval debulking surgery specifically, bevacizumab should be withheld for 6 weeks before the procedure 6

Bevacizumab should not be reinitiated until at least 6-8 weeks postoperatively to ensure adequate wound healing 2, 3

The National Comprehensive Cancer Network states that bevacizumab significantly interferes with wound healing, and clinical trial data demonstrate that wound healing complications occurred in 13% of patients versus 3.4% with chemotherapy alone (P=0.28) 4, 5
However, when bevacizumab was stopped at least 6 weeks before surgery, wound healing complications dropped to only 1.3% versus 0.5% with chemotherapy alone (P=0.63) 4, 5
There is an increased risk of gastrointestinal perforation, particularly in patients with extensive prior intra-abdominal surgery 4, 5
There is a risk of necrotizing fasciitis (sometimes fatal), usually secondary to wound healing complications, GI perforation, or fistula formation 4

If the 3rd dose would fall within 6 weeks of planned surgery, it must be omitted or the surgery delayed, as recommended by the National Comprehensive Cancer Network 2, 3, 4
The American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend calculating backward from the surgical date to determine the optimal timing of bevacizumab doses 6