Background Previous studies suggest a possible sex-specific response to bevacizumab in metastatic colorectal carcinoma, showing a benefit in males, while the effect in females is less significant. Methods Data from 3369 metastatic colorectal carcinoma patients enrolled on four first-line randomized trials testing chemotherapy with or without bevacizumab (2000-2007) were pooled. Association between sex and progression-free survival and overall survival was evaluated by stratified Cox regression model, adjusted for potential confounders. Predictive value was evaluated by interaction effect between sex and treatment. In a pre-planned secondary analysis, analyses were stratified using an age cut-point of 60 years to evaluate the possible role of menopausal-related effects. Results Bevacizumab was associated with an improved median overall survival in males and females, with a 2.3- and 0.6-months benefit, respectively. Stratified by age, bevacizumab resulted in improved overall survival in males at both age categories. In females at or above the age of 60 (n=731), bevacizumab resulted in improved overall survival. However, in females below the age of 60 (n=634), overall survival benefit did not reach statistical significance (adjusted hazard ratio=0.94, 95% CI 0.74-1.20). Conclusions Our results confirmed the overall survival benefit from addition of bevacizumab to first-line chemotherapy in metastatic colorectal carcinoma in both sexes. Among females, the benefit was less than 1 month. For females under the age of 60, there was no survival benefit. These findings could be used to relieve financial toxicity or be redistributed within healthcare systems for other health-related purposes.