Department of Laparoscopic Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
Department of Laparoscopic Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China. Email:
Chin Med J (Engl). 2014;127(3):538-46.
What benefits and toxicities patients acquire from the use of bevacizumab combined with firstline chemotherapy remains controversial. This study was performed to evaluate the efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer (mCRC).
Several databases, including PubMed, Embase, and Cochrane Library, were searched up to April 30, 2013. Eligible studies were only randomized, controlled trials (RCTs) with a direct comparison between mCRC patients treated with and without bevacizumab. Overall risk ratio (RR), hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CI) were calculated employing fixed or random-effects models depending on the heterogeneity of the included trials.
Six RCTs, including 1582 patients in chemotherapy plus bevacizumab group and 1484 patients in chemotherapyalone group, were included. Overall, the addition of bevacizumab to first-line chemotherapy increased overall response rate (ORR) by 4.5%, prolonged both progression-free survival (PFS) and overall survival (OS), and increased the rate of total Grades 3 or 4 adverse events (G3/4AEs) by 6.9%. Significant differences were found in ORR (RR = 1.22 (95% CI 1.01-1.46), P = 0.03), PFS (HR = 0.60 (95% CI 0.47-0.77), P < 0.0001), OS (HR = 0.83 (95% CI 0.70-0.97), P = 0.02), and any G3/4AEs (OR = 1.56 (95% CI 1.29-1.89), P < 0.00001).
Bevacizumab is a valuable addition to the current first-line chemotherapy regimens used in patients with mCRC, because of conferring a significant improvement in ORR, PFS, and OS, even though it increased adverse events.
贝伐珠单抗联合一线化疗为转移性结直肠癌（mCRC）患者带来的获益和毒性仍存在争议。本研究旨在评估一线化疗联合贝伐珠单抗治疗 mCRC 患者的疗效和安全性。
检索了 PubMed、Embase 和 Cochrane Library 等数据库，检索时限截至 2013 年 4 月 30 日。纳入的研究为 mCRC 患者接受贝伐珠单抗与未接受贝伐珠单抗治疗的直接比较的随机对照试验（RCT）。采用固定或随机效应模型计算总风险比（RR）、风险比（HR）、比值比（OR）和 95%置信区间（CI），根据纳入试验的异质性进行选择。
共纳入 6 项 RCT，贝伐珠单抗联合化疗组 1582 例，单纯化疗组 1484 例。总体而言，贝伐珠单抗联合一线化疗使总缓解率（ORR）提高了 4.5%，无进展生存期（PFS）和总生存期（OS）均延长，3 级或 4 级不良事件（G3/4AEs）发生率增加了 6.9%。ORR（RR=1.22（95%CI 1.01-1.46），P=0.03）、PFS（HR=0.60（95%CI 0.47-0.77），P<0.0001）、OS（HR=0.83（95%CI 0.70-0.97），P=0.02）和任何 G3/4AEs（OR=1.56（95%CI 1.29-1.89），P<0.00001）均有显著差异。
贝伐珠单抗是 mCRC 患者当前一线化疗方案的有价值的补充，可显著提高 ORR、PFS 和 OS，尽管增加了不良反应。
