Bevacizumab and MRONJ — MFDS Part 1 MCQ

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HardPharmacologyBevacizumab and MRONJMFDS Part 1

An oncology letter describes a systemic anticancer drug as a recombinant humanised monoclonal antibody that neutralises vascular endothelial growth factor (VEGF), preventing its binding to VEGFR-1 and VEGFR-2. Osteonecrosis of the jaw has been reported during treatment with this drug. Which drug is being described?

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Correct answer: E — Bevacizumab

Bevacizumab is a recombinant humanised monoclonal antibody that binds VEGF, preventing activation of VEGFR-1 and VEGFR-2 and thereby inhibiting tumour angiogenesis. Its UK SmPC reports osteonecrosis of the jaw, particularly where additional risk factors such as intravenous bisphosphonate exposure or invasive dental disease are present; SDCEP lists it among antiangiogenic drugs associated with MRONJ. Ramucirumab instead targets VEGFR-2 itself. Cetuximab targets EGFR, trastuzumab targets HER2 and rituximab targets CD20. Thus, the combination of direct VEGF neutralisation and a recognised ONJ association uniquely identifies bevacizumab.

Reference: Electronic Medicines Compendium, Avastin 25 mg/ml concentrate for solution for infusion, Summary of Product Characteristics, sections 4.4 and 5.1, updated 18 May 2026. https://www.medicines.org.uk/emc/product/3885/smpc