Do you have a higher threshold regarding when to hold bevacizumab for proteinuria in patients who had known baseline proteinuria from diabetic nephropathy?

This is an interesting question. It’s not uncommon to have patients with cancer who have other underlying conditions that may lead to proteinuria. I don’t have a higher or lower threshold to recommend holding VEGF inhibitors, but in all patients who are on them who develop proteinuria, the degree of proteinuria is important as is accompanying blood pressure control and response to RAAS inhibition. While the package insert for these drugs generally says to hold if proteinuria >2g, I’ve tolerated ...

I agree with Dr. @Dr. First Last. Each patient has their associated comorbidities and their response to bevacizumab and availability of other therapeutic options do factor into the decision-making regarding tolerable levels of proteinuria. The proteinuria trend also factors into decision-making. If the patient has a stable amount of proteinuria and they are responding to bevacizumab, one can still manage expectantly -albeit closely.