Bevacizumab Combined With Chemotherapy For Ovarian Cancer:An Updated Systematic Review And Meta-analysis

Background: This meta-analysis was updated with results from a new trial and final data to reassess the efficacy and safety of bevacizumab combined with chemotherapy in ovarian cancer(OC).Methods: Randomized controlled trials(RCTs)were searched in PubMed,EMBASE,Cochrane clinical trials,Web of Science and clinicaltrial.gov databases.Outcomes included the progression-free survival(PFS),overall survival(OS),objective response rate(ORR)and common adverse events.The hazard ratio(HR),risk ratio(RR)and odds ratio(OR)were pooled when the meta-analysis was performed.Results: Five RCTs with 4994 patients were included.In overall newly diagnosed OC,bevacizumab combined with chemotherapy did not significantly improve PFS(HR 0.85,95%CI 0.70-1.02)or OS(HR 0.94,95%CI 0.84-1.05).In the high-risk progression subgroup,the addition of bevacizumab significantly improved PFS(HR 0.76,95%CI 0.68-0.84)and OS(HR 0.85,95%CI 0.74-0.96).In recurrent OC,the addition of bevacizumab to chemotherapy significantly extended PFS(HR 0.53,95%CI 0.45-0.63)and OS(HR 0.87,95%CI 0.77-0.99).The ORR was improved(OR 2.37,95%CI 1.99-2.82)in the overall population.Bevacizumab increased the incidence of hypertension(RR 21.27,95%CI 9.42-48.02),proteinuria(RR 4.77,95%CI 2.15-10.61),bleeding(RR 3.16,95%CI 1.59-6.30),GI perforations(RR 2.76,95%CI 1.51-5.03),arterial thrombosis events(RR 2.39,95%CI 1.39-4.10)and venous thrombosis events(RR 1.43,95%CI 1.04-1.96).Conclusions: Bevacizumab combined with chemotherapy significantly improved PFS and OS in both patients with high-risk of progression and patients with recurrent OC,with an increased incidence of common adverse events.However,no statistically significant survival benefit was identified in the front-line settings.