Bevacizumab combination therapy versus standard chemotherapy for ovarian cancer in shorter and longer followup duration: A systematic review and meta-analysis of randomized controlled trials.

Abstract

e23296 Background: Bevacizumab is an anti-angiogenesis drug commonly added to standard chemotherapy regimens in the treatment of ovarian cancer. However, its comparative efficacy and safety in shorter and longer followup duration leaves a research gap that needs to be addressed. This systematic review and meta-analysis aims to evaluate the efficacy and safety of bevacizumab in patients with ovarian cancer in shorter and longer follow up duration. Methods: We searched Medline, Cochrane CENTRAL, Scopus, and Google Scholar for all phase 3 randomized controlled trials (RCTs) that administered bevacizumab to women with ovarian cancer. Review Manager 5.4 was used to calculate risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (95% CIs). We assessed the quality of included studies using version 2 of the Cochrane Risk of Bias tool (RoB 2). Results: After screening the titles, abstracts, and full texts, we included nine RCTs in our systematic review and meta-analysis. Four RCTs had low risk of bias while five had some concerns. Bevacizumab was associated with a progression free survival benefit for < 36 months (HR 0.59, 95% CI 0.45 to 0.76, p < 0.0001, I2= 90%) and > 36 months (HR 0.66, 95% CI 0.55 to 0.80, p < 0.0001, I2= 80%), and an overall survival benefit for < 36 months (HR 0.87, 95% CI 0.78 to 0.98, p = 0.02, I2= 0%) but not for > 36 months (HR 0.98, 95% CI 0.89 to 1.09, p = 0.77, I2= 30%). There was no difference in deaths between intervention and control groups < 36 months (RR = 0.95, 95% CI 0.86 to 1.04, p = 0.26, I2= 10%) or > 36 months (RR 1.02, 95% CI 0.97 to 1.06, p = 0.50, I2= 0%). Bevacizumab reduced disease progression < 36 months (RR 0.82, 95% CI 0.72 to 0.92, p = 0.0008, I2= 82%) but not at > 36 months (RR 0.83, 95% CI 0.58 to 1.19, p = 0.30, I2= 94%). The adverse events reported with Bevacizumab use included thrombocytopenia, neutropenia, leukocytopenia, anemia, hypertension, bleeding or hemorrhage, and gastrointestinal, cardiac, and dermatological adverse events. Conclusions: Bevacizumab may improve progression free survival within and after 36 months, overall survival within 36 months, and reduce disease progression within 36 months. Future studies should explore the long-term effectiveness of bevacizumab in diverse patient populations and focus on individual patient-tailored treatment approaches to optimize outcomes.