Bevacizumab-induced normalization of blood vessels in tumors hampers antibody uptake

Cancer Res. 2013 Jun 1;73(11):3347-55. doi: 10.1158/0008-5472.CAN-12-3518. Epub 2013 Apr 11.


In solid tumors, angiogenesis occurs in the setting of a defective vasculature and impaired lymphatic drainage that is associated with increased vascular permeability and enhanced tumor permeability. These universal aspects of the tumor microenvironment can have a marked influence on intratumoral drug delivery that may often be underappreciated. In this study, we investigated the effect of blood vessel normalization in tumors by the antiangiogenic drug bevacizumab on antibody uptake by tumors. In mouse xenograft models of human ovarian and esophageal cancer (SKOV-3 and OE19), we evaluated antibody uptake in tumors by positron emission tomographic imaging 24 and 144 hours after injection of (89)Zr-trastuzumab (SKOV-3 and OE19), (89)Zr-bevacizumab (SKOV-3), or (89)Zr-IgG (SKOV-3) before or after treatment with bevacizumab. Intratumor distribution was assessed by fluorescence microscopy along with mean vessel density (MVD) and vessel normalization. Notably, bevacizumab treatment decreased tumor uptake and intratumoral accumulation compared with baseline in the tumor models relative to controls. Bevacizumab treatment also reduced MVD in tumors and increased vessel pericyte coverage. These findings are clinically important, suggesting caution in designing combinatorial trials with therapeutic antibodies due to a possible reduction in tumoral accumulation that may be caused by bevacizumab cotreatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiogenesis Inhibitors / pharmacology
  • Animals
  • Antibodies, Monoclonal, Humanized / pharmacokinetics*
  • Antibodies, Monoclonal, Humanized / pharmacology*
  • Antineoplastic Agents / pharmacokinetics
  • Bevacizumab
  • Cell Line, Tumor
  • Drug Interactions
  • Esophageal Neoplasms / blood supply
  • Esophageal Neoplasms / diagnostic imaging
  • Esophageal Neoplasms / drug therapy*
  • Esophageal Neoplasms / metabolism*
  • Female
  • Humans
  • Immunoglobulin G / metabolism*
  • Male
  • Mice
  • Mice, Nude
  • Neovascularization, Pathologic / drug therapy
  • Neovascularization, Pathologic / metabolism
  • Ovarian Neoplasms / blood supply
  • Ovarian Neoplasms / diagnostic imaging
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / metabolism*
  • Positron-Emission Tomography
  • Radioisotopes
  • Radiopharmaceuticals / pharmacokinetics
  • Trastuzumab
  • Xenograft Model Antitumor Assays
  • Zirconium / pharmacokinetics


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Immunoglobulin G
  • Radioisotopes
  • Radiopharmaceuticals
  • Bevacizumab
  • Zirconium
  • Trastuzumab