What are your recommendations for holding bevacizumab before and after SBRT to the lung?

As @Dr. First Last notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This work w...

I would just not use SBRT when bevacizumab has been (or will be) applied. Please see the slides from my ASTRO Lung Highlights last fall, with the discussion of the Wang’s abstract, which reports on very severe toxicity of such combination.

There are a few issues that need to be addressed in regard to the use of stereotactic body radiation therapy before and after bevacizumab for thoracic malignancies. I personally do not believe it is an absolute contraindication but it should not be a frequent occurrence, and I do not use for central...

Avastin has a LONG half life from 0.5 to 1.5 months.

Most of the reported grade 5 toxicities for central/ultra central SBRT have been bleeding in the context of current/previous Avastin administration. The absolute risk is low, but certainly real enough to give pause. We must be cognizant of being t...