Abstract
Bevacizumab, as antibodies, were applied to inhibit tumor angiogenesis by preventing activation of vascular endothelial growth factor receptor. We analyzed four clinical trials, including 607 patients, to investigate the efficacy and safety of bevacizumab when combined with chemotherapy for the treatment of glioblastomas. Results demonstrated that bevacizumab when combined with chemotherapy improved progression-free survival (HR = 0.66; 95% CI 0.56–0.78; p < 0.00001) compared with bevacizumab or chemotherapy alone. Furthermore, overall survival showed insignificant difference between two arms (HR 0.99; 95% CI 0.8–1.21; p = 0.92). However, we found that patients treated with bevacizumab-containing therapy reported increased objective response rate (OR 1.85, 95% CI 1.17–2.93; p = 0.009), but more treatment-related adverse events (OR 1.75; 95% CI 1.09–2.83; p = 0.02).
Highlights
Glioblastoma (GBM, WHO grade IV) is the most common brain tumor, accounting for 15.1% of all primary brain tumors and 46.1% of all malignant brain tumors
Results demonstrated that bevacizumab when combined with chemotherapy improved progression-free survival (HR = 0.66; 95% confidence intervals (CIs) 0.56–0.78; p < 0.00001) compared with bevacizumab or chemotherapy alone
The results indicated that bevacizumab combined with chemotherapy prolonged progression-free survival (PFS) in recurrent GBM patients (HR 0.70; 95% CI 0.57–0.85; p = 0.0005; Figure 3)
Summary
Glioblastoma (GBM, WHO grade IV) is the most common brain tumor, accounting for 15.1% of all primary brain tumors and 46.1% of all malignant brain tumors. The assessed number of cases of GBMs in the United States for 2015 and 2016 are 11,890 and 12,120, respectively [1]. GBM is typical of aggressiveness and always indicate a poor prognosis. GBMs are composed of densed and highly disorganized vessels [3, 4] .These highly disorganized vessel architectures critically contribute to rapid tumor growth and resistance to radiotherapy and chemotherapy. Vascular endothelial growth factor (VEGF) is a crucial factor in these signal passways affecting angiogenesis [5]. GBM cells present a high level of VEGFs and were correlated to aggressiveness and prognosis [6]. The inhibition of VEGF is assumed to slow down tumor growth and enhance the effects of radiotherapy and chemotherapy [7, 8]
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