Abstract
BackgroundWith the wide application of targeted drug therapies, the relevance of prognostic and predictive markers in patient selection has become increasingly important. Bevacizumab is commonly used in combination with chemotherapy in the treatment of metastatic colorectal cancer. However, there are currently no predictive or prognostic biomarkers for bevacizumab. Several clinical studies have evaluated bevacizumab-induced hypertension in patients with metastatic colorectal cancer. This meta-analysis was performed to better determine the association of bevacizumab-induced hypertension with outcome in patients with metastatic colorectal cancer, and to assess whether bevacizumab-induced hypertension can be used as a prognostic factor in these patients.MethodsWe performed a systematic review and meta-analysis on seven published studies to investigate the relationship between hypertension and outcome of patients with metastatic colorectal cancer treated with bevacizumab. Our primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS) and overall response rate (ORR). Hazard ratios (HRs) for PFS and OS were extracted from each trial, and the log of the relative risk ratio (RR) was estimated for ORR.ResultsThe occurrence of bevacizumab-induced hypertension in patients was highly associated with improvements in PFS (HR = 0.57, 95% CI: 0.46–0.72; P <0.001), OS (HR = 0.50; 95% CI: 0.37–0.68; P <0.001), and ORR (RR = 1.57, 95% CI: 1.07–2.30, P <0.05), as compared to patients without hypertension.ConclusionsBevacizumab-induced hypertension may represent a prognostic factor in patients with metastatic colorectal cancer.
Highlights
With the wide application of targeted drug therapies, the relevance of prognostic and predictive markers in patient selection has become increasingly important
Bevacizumab has been demonstrated to be relatively safe in association with either irinotecan [13] or oxaliplatin-containing chemotherapy regimens [14], while its specific toxicity profile appears manageable by applying appropriate clinical selection criteria [15]
We did an extensive search of PubMed to retrieve relevant literature that reported the predictive value of hypertension regarding response and/or progression and/or survival in metastatic CRC (mCRC) patients treated with bevacizumab
Summary
With the wide application of targeted drug therapies, the relevance of prognostic and predictive markers in patient selection has become increasingly important. Bevacizumab is commonly used in combination with chemotherapy in the treatment of metastatic colorectal cancer. Several clinical studies have evaluated bevacizumab-induced hypertension in patients with metastatic colorectal cancer. This meta-analysis was performed to better determine the association of bevacizumab-induced hypertension with outcome in patients with metastatic colorectal cancer, and to assess whether bevacizumab-induced hypertension can be used as a prognostic factor in these patients. Vascular endothelial growth factor (VEGF) is the major factor involved in tumor angiogenesis [2]. It promotes endothelial cell survival, migration, and. Treatment with bevacizumab is associated with various adverse reactions such as gastrointestinal perforations, wound healing complications, hemorrhage, arterial thrombotic events, infection, proteinuria, and hypertension. Bevacizumab has been demonstrated to be relatively safe in association with either irinotecan [13] or oxaliplatin-containing chemotherapy regimens [14], while its specific toxicity profile appears manageable by applying appropriate clinical selection criteria [15]
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