Abstract
Bevacizumab is a recombinant humanized monoclonal antibody against vascular endothelial growth factor which has been used in conjunction with other anti-cancer agents in the treatment of patients with many cancers. It remains controversial whether bevacizumab can prolong survival in cancer patients. This meta-analysis was therefore performed to evaluate effect of bevacizumab on survival in cancer patients. PubMed, EMBASE, and Web of Science databases were searched for English-language studies of randomized controlled trials comparing bevacizumab with control therapy published through February 8, 2012. Progression-free survival, overall survival, and one-year survival rate were analyzed using random- or fixed-effects model. Thirty one assessable randomized controlled trials were identified. A significant improvement in progression-free survival in cancer patients was attributable to bevacizumab compared with control therapy (hazard ratio, 0.72; 95% confidence interval, 0.68 to 0.76; p<0.001). Overall survival was also significantly longer in patients were treated with bevacizumab (hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.91; p<0.001). The significant benefit in one-year survival rate was further seen in cancer patients receiving bevacizumab (odds ratio, 1.30; 95% confidence interval, 1.20 to 1.41; p<0.001). Current evidences showed that bevacizumab prolong progression-free survival and overall survival, and increase one-year survival rate in cancer patients as compared with control therapy.
Highlights
Angiogenesis is a universal requirement for the growth of solid tumors beyond the limits of oxygen diffusion from the existing vasculature, and plays a crucial role in the growth and metastasis of cancer [1]
Bevacizumab monotherapy has been notably less studied in cancer patients than bevacizumab combined with chemotherapy, and fatal adverse events have been reported in cancer patients treated with bevacizumab in combination with chemotherapy [5]
Reporting randomized controlled trials (RCTs) results with bevacizumab in patients with various cancers were considered to be eligible for inclusion in the analysis (Figure 1)
Summary
Angiogenesis is a universal requirement for the growth of solid tumors beyond the limits of oxygen diffusion from the existing vasculature, and plays a crucial role in the growth and metastasis of cancer [1]. The experimental in vivo inhibition of the VEGF pathway results in tumor growth inhibition and improves delivery of chemotherapeutic drugs by reducing tumor interstitial fluid pressure and by changing vessel diameter, density, and permeability in response to treatment [3]. These data prompted the clinical investigation of bevacizumab (Avastin; Genentech, South San Francisco, CA), a humanized anti-VEGF monoclonal IgG1 antibody in the treatment of cancer patients. In a recent meta-analysis, Ranpura et al [6] have reported that bevacizumab in combination with chemotherapy or biological therapy was associated with increased treatment-related mortality as compared with chemotherapy alone. To better understand the overall impact of bevacizumab on survival of patients with cancer, we conducted a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effect of bevacizumab on progression-free survival (PFS), overall survival (OS), and one-year survival rate (OYSR) in patients with cancer
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