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贝伐单抗联合化疗治疗卵巢癌：随机对照试验的最新系统评价和荟萃分析

Bevacizumab combined with chemotherapy for ovarian cancer: an updated systematic review and meta-analysis of randomized controlled trials.

作者信息

Wu Yu Shen, Shui Lin, Shen Dan, Chen Xiaopin

机构信息

Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.

出版信息

Oncotarget. 2017 Feb 7;8(6):10703-10713. doi: 10.18632/oncotarget.12926.

DOI:10.18632/oncotarget.12926
PMID:27793044
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5354693/
Abstract

BACKGROUND

This meta-analysis was updated with results from a new trial and final data to reassess the efficacy and safety of bevacizumab combined with chemotherapy in ovarian cancer (OC).

METHODS

Randomized controlled trials (RCTs) were searched in PubMed, EMBASE, Cochrane clinical trials, Web of Science and clinicaltrial.gov databases. Outcomes included the progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and common adverse events. The hazard ratio (HR), risk ratio (RR) and odds ratio (OR) were pooled when the meta-analysis was performed.

RESULTS

Five RCTs with 4994 patients were included. In overall newly diagnosed OC, bevacizumab combined with chemotherapy did not significantly improve PFS (HR 0.85, 95%CI 0.70-1.02) or OS (HR 0.94, 95%CI 0.84-1.05). In the high-risk progression subgroup, the addition of bevacizumab significantly improved PFS (HR 0.76, 95%CI 0.68-0.84) and OS (HR 0.85, 95%CI 0.74-0.96). In recurrent OC, the addition of bevacizumab to chemotherapy significantly extended PFS (HR 0.53, 95%CI 0.45-0.63) and OS (HR 0.87, 95%CI 0.77-0.99). The ORR was improved (OR 2.37, 95%CI 1.99-2.82) in the overall population. Bevacizumab increased the incidence of hypertension (RR 21.27, 95%CI 9.42-48.02), proteinuria (RR 4.77, 95%CI 2.15-10.61), bleeding (RR 3.16, 95%CI 1.59-6.30), GI perforations (RR 2.76, 95%CI 1.51-5.03), arterial thrombosis events (RR 2.39, 95%CI 1.39-4.10) and venous thrombosis events (RR 1.43, 95%CI 1.04-1.96).

CONCLUSIONS

Bevacizumab combined with chemotherapy significantly improved PFS and OS in both patients with high-risk of progression and patients with recurrent OC, with an increased incidence of common adverse events. However, no statistically significant survival benefit was identified in the front-line settings.

摘要

背景

本荟萃分析纳入了一项新试验的结果和最终数据，以重新评估贝伐单抗联合化疗治疗卵巢癌（OC）的疗效和安全性。

方法

在PubMed、EMBASE、Cochrane临床试验、Web of Science和clinicaltrial.gov数据库中检索随机对照试验（RCT）。结局指标包括无进展生存期（PFS）、总生存期（OS）、客观缓解率（ORR）和常见不良事件。进行荟萃分析时汇总风险比（HR）、风险率（RR）和比值比（OR）。

结果

纳入了5项RCT，共4994例患者。在总体新诊断的OC中，贝伐单抗联合化疗未显著改善PFS（HR 0.85，95%CI 0.70 - 1.02）或OS（HR 0.94，95%CI 0.84 - 1.05）。在高危进展亚组中，添加贝伐单抗显著改善了PFS（HR 0.76，95%CI 0.68 - 0.84）和OS（HR 0.85，95%CI 0.74 - 0.96）。在复发性OC中，化疗联合贝伐单抗显著延长了PFS（HR 0.53，95%CI 0.45 - 0.63）和OS（HR 0.87，95%CI 0.77 - 0.99）。总体人群的ORR有所改善（OR 2.37，95%CI 1.99 - 2.82）。贝伐单抗增加了高血压（RR 21.27，95%CI 9.42 - 48.02）、蛋白尿（RR 4.77，95%CI 2.15 - 10.61）、出血（RR 3.16，95%CI 1.59 - 6.30）、胃肠道穿孔（RR 2.76，95%CI 1.51 - 5.03）、动脉血栓事件（RR 2.39，95%CI 1.39 - 4.10）和静脉血栓事件（RR 1.43，95%CI 1.04 - 1.96）的发生率。

结论

贝伐单抗联合化疗在进展高危患者和复发性OC患者中均显著改善了PFS和OS，但常见不良事件的发生率增加。然而在一线治疗中未发现有统计学意义的生存获益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/d3f00df4cbad/oncotarget-08-10703-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/fda82c61aaf4/oncotarget-08-10703-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/8a1a6c4635e0/oncotarget-08-10703-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/e8fbddd42808/oncotarget-08-10703-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/8cc9d8e6c1cb/oncotarget-08-10703-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/9c866d7648c3/oncotarget-08-10703-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/2690d510ea71/oncotarget-08-10703-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/d3f00df4cbad/oncotarget-08-10703-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/fda82c61aaf4/oncotarget-08-10703-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/8a1a6c4635e0/oncotarget-08-10703-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/e8fbddd42808/oncotarget-08-10703-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/8cc9d8e6c1cb/oncotarget-08-10703-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/9c866d7648c3/oncotarget-08-10703-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/2690d510ea71/oncotarget-08-10703-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/257a/5354693/d3f00df4cbad/oncotarget-08-10703-g007.jpg

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