Abstract
PurposeResults from previous randomised controlled trials (RCTs) investigating whether the addition of bevacizumab to neoadjuvant chemotherapy (NAC) could statistically significantly increase the pathological complete response (pCR) and to identify which subgroup would benefit most from such regimens have produced conflicting results. This meta-analysis was designed to assess the efficacy and safety of bevacizumab plus chemotherapy compared with chemotherapy alone in the neoadjuvant setting.MethodsA literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane library was performed to identify eligible studies. The primary endpoint of interest was pCR. The secondary endpoints were clinical complete rate (cCR), surgery rate, breast-conserving surgery (BCS) rate, and toxicity. The meta-analysis was performed using Review Manager software version 5.3.ResultsNine RCTs matched the selection criteria, yielding a total of 4967 patients (bevacizumab plus chemotherapy: 50.1%, chemotherapy alone: 49.9%). The results of this meta-analysis demonstrated that the addition of bevacizumab to NAC significantly increased the pCR rate (odds ratio [OR] = 1.34 [1.18–1.54]; P < 0.0001) compared with chemotherapy alone. Subgroup analysis showed that the effect of bevacizumab was more pronounced in patients with HER2-negative cancer (OR = 1.34 [1.17–1.54]; P < 0.0001) compared with HER2-positive cancer (OR = 1.69 [0.90–3.20]; P = 0.11). Similarly, in patients with HER2-negative cancer, the effect of bevacizumab was also more pronounced in patients with HR-negative cancer (OR = 1.38 [1.09–1.74]; P = 0.007) compared with HR-positive cancer (OR = 1.36 [0.78–2.35]; P = 0.27). No significant differences were observed between the groups with respect to cCR, surgery rate, or BCS rate. Additionally bevacizumab was associated with a higher incidence of neutropenia, febrile neutropenia, and hand–foot syndrome.ConclusionsHigher proportions of patients achieved pCR when bevacizumab was added to NAC compared with when they received chemotherapy alone; acceptable toxicities were also found. Subgroup analysis demonstrated that patients with histologically confirmed HER2-negative and HR-negative breast cancer benefited the most.
Highlights
Neoadjuvant chemotherapy (NAC), known as primary or preoperative chemotherapy, has been widely used in patients with locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC)
Nine randomised controlled trials (RCTs) matched the selection criteria, yielding a total of 4967 patients. The results of this meta-analysis demonstrated that the addition of bevacizumab to NAC significantly increased the pathologic complete response (pCR) rate compared with chemotherapy alone
Higher proportions of patients achieved pCR when bevacizumab was added to NAC compared with when they received chemotherapy alone; acceptable toxicities were found
Summary
Neoadjuvant chemotherapy (NAC), known as primary or preoperative chemotherapy, has been widely used in patients with locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC). Among the definitions of the response to NAC, pathologic complete response (pCR) has been shown to yield predicted improved long-term outcomes in several neoadjuvant studies and represents a potential surrogate marker of survival. These trials indicated that patients who achieve a pCR after NAC may had better overall survival (OS), disease-free survival (DFS) or event-free survival (EFS) compared with matched patients having only a partial pathological resonse (pPR) [6, 8, 9]. Multiple NAC regimens have emerged to help patients achieve pCR In these regimens, bevacizumab is drawing increasing attention
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