The use of bevacizumab in the modern era of targeted therapy for ovarian cancer: A systematic review and meta-analysis
| Autor: | Stephanie Lheureux, Lawrence Kasherman, Rouhi Fazelzad, Genevieve Bouchard-Fortier, Lisa Wang, Shiru Liu, Monika K. Krzyzanowska |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Bevacizumab Combination therapy medicine.medical_treatment law.invention Targeted therapy 03 medical and health sciences Clinical Trials Phase II as Topic 0302 clinical medicine Randomized controlled trial law Internal medicine Antineoplastic Combined Chemotherapy Protocols Humans Medicine Molecular Targeted Therapy Randomized Controlled Trials as Topic Ovarian Neoplasms business.industry Hazard ratio Obstetrics and Gynecology Progression-Free Survival Survival Rate Clinical trial 030104 developmental biology Systematic review Clinical Trials Phase III as Topic 030220 oncology & carcinogenesis Meta-analysis Female business medicine.drug |
| Zdroj: | Gynecologic Oncology. 161:601-612 |
| ISSN: | 0090-8258 |
| DOI: | 10.1016/j.ygyno.2021.01.028 |
| Popis: | Objectives The optimal systemic therapy strategy for advanced epithelial ovarian cancer (EOC) remains unclear. We performed a systematic review and meta-analysis to assess oncologic outcomes and toxicity of bevacizumab combination treatment in advanced EOC. Methods We conducted an electronic search of all phase 2 and 3 clinical trials involving bevacizumab combination therapy in advanced-stage EOC between 2010 and March 2020, using Embase, Medline, Epub Ahead of Print, Cochrane for clinical trials, Cochrane Database of Systematic Reviews, Web of Science and clinicaltrials.gov databases. Progression-free survival (PFS), overall survival (OS), and their hazard ratios (HR) when available were extracted. Pooled HR were calculated for each efficacy endpoint in the meta-analysis using inverse variance weighted method. Bias was assessed using the Cochrane Collaboration Risk of Bias I (ROB1) tool for randomized controlled trials. Results Thirty-five studies were included in the qualitative analysis and eight studies in the quantitative synthesis. In the first-line setting, bevacizumab combined with chemotherapy revealed a significant improvement in PFS (pooled HR = 0.72, 95% CI 0.65–0.81) when compared to chemotherapy alone but no significant OS benefit (pooled HR = 0.88, 95% CI 0.72–1.06). In the recurrent setting, bevacizumab combinations showed significant PFS (pooled HR = 0.52, 95% CI 0.47–0.58) and OS benefits (pooled HR = 0.88, 95% CI 0.79–0.99) compared with non-bevacizumab regimens. Rate of bowel perforation was low at 1.24% (range 0–4.2%). Conclusions Bevacizumab-containing regimens are associated with significant PFS benefit in advanced and recurrent epithelial ovarian cancer. While the difference in OS did not reach statistical significance in the first-line setting, bevacizumab was associated with improved survival in the recurrent setting. |
| Databáze: | OpenAIRE |
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