Li Cunfu, Xiang Aizhai, Chen Xianzhi, Yin Kai, Lu Jinsong, Yin Wenjin
Department of General Surgery, Weihai Central Hospital, Weihai.
Department of Breast Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou.
Onco Targets Ther. 2017 Jun 27;10:3155-3168. doi: 10.2147/OTT.S138600. eCollection 2017.
Manifold data have demonstrated that the addition of bevacizumab to chemotherapy improved progression-free survival (PFS), while few trials have revealed its significant overall survival (OS) benefit. Furthermore, it still remains suspended how to maximize the benefits of bevacizumab as first-line therapy for human epidermal growth factor receptor 2 (HER2)-negative breast cancer. We sought to conduct a meta-analysis to assess the benefits of bevacizumab with chemotherapy and to identify the ideal chemotherapy partner of bevacizumab in the first-line setting for HER2-negative advanced breast cancer patients.
Computerized and manual searches were performed to identify randomized clinical trials evaluating the efficacy of bevacizumab plus chemotherapy versus chemotherapy alone or bevacizumab with different chemotherapy regimens as first-line therapy for HER2-negative locally recurrent or metastatic breast cancer patients. Risk ratios or odds ratios with their 95% CIs were used to estimate the association between multiple combinations of bevacizumab with chemotherapy and various clinical outcomes.
With 7 trials identified, this analysis included 3,984 eligible patients. The addition of bevacizumab to chemotherapy resulted in a statistically significant improvement in PFS (=0.019) and objective response rate (ORR; <0.001) rather than in OS (=0.783) when compared with chemotherapy alone. The greater benefits in PFS and ORR were achieved from bevacizumab plus taxane-based regimens compared with bevacizumab plus capecitabine-based regimens, while bevacizumab plus capecitabine had comparable OS with bevacizumab plus paclitaxel. Additionally, bevacizumab-based triplet therapy failed to improve the clinical outcomes when compared with doublet therapy.
This meta-analysis reveals that the addition of bevacizumab to chemotherapy yielded PFS and ORR benefits in HER2-negative advanced breast cancer. Additional studies are still prompted to further optimize the first-line treatment of bevacizumab.
多项数据表明，在化疗中添加贝伐单抗可改善无进展生存期（PFS），但很少有试验显示其对总生存期（OS）有显著益处。此外，对于如何将贝伐单抗作为人表皮生长因子受体2（HER2）阴性乳腺癌的一线治疗方案的益处最大化，目前仍尚无定论。我们试图进行一项荟萃分析，以评估贝伐单抗联合化疗的益处，并确定在HER2阴性晚期乳腺癌患者的一线治疗中，贝伐单抗的理想化疗搭档。
通过计算机检索和手动检索，以确定评估贝伐单抗联合化疗与单纯化疗或贝伐单抗联合不同化疗方案作为HER2阴性局部复发或转移性乳腺癌患者一线治疗疗效的随机临床试验。风险比或比值比及其95%置信区间用于估计贝伐单抗与化疗的多种组合与各种临床结局之间的关联。
共纳入7项试验，分析包括3984例符合条件的患者。与单纯化疗相比，在化疗中添加贝伐单抗可使PFS（P=0.019）和客观缓解率（ORR；P<0.001）有统计学意义的改善，但对OS无显著影响（P=0.783）。与贝伐单抗联合卡培他滨方案相比，贝伐单抗联合紫杉类方案在PFS和ORR方面有更大益处，而贝伐单抗联合卡培他滨的OS与贝伐单抗联合紫杉醇相当。此外，与双联疗法相比，基于贝伐单抗的三联疗法未能改善临床结局。
这项荟萃分析表明，在化疗中添加贝伐单抗可使HER2阴性晚期乳腺癌患者的PFS和ORR获益。仍需进一步研究以进一步优化贝伐单抗的一线治疗方案。
