Liao Ke-Li, Huang Song, Wu Yu-Peng
Department of Neurosurgery, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China.
Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Onco Targets Ther. 2018 Jun 19;11:3513-3520. doi: 10.2147/OTT.S156723. eCollection 2018.
A combination of temozolomide (TMZ) and radiotherapy and subsequent adjuvant chemotherapy is the gold standard of treatment for glioblastoma (GB). Bevacizumab (BEV), a humanized monoclonal antibody that blocks the effects of vascular endothelial growth factor A, has produced impressive response rates for recurrent GB and has been approved as second-line therapy. The efficacy and safety of BEV in newly diagnosed GB are not known.
This systematic meta-analysis was undertaken to evaluate the value of combination therapy involving BEV in newly diagnosed GB.
Electronic databases were searched for eligible literature up to October 2017. Randomized controlled trials assessing the efficacy and safety of BEV in patients with newly diagnosed GB were included, of which the main outcomes were progression-free survival (PFS), overall survival (OS), and adverse events (AEs). All the data were pooled with the corresponding 95% confidence intervals (CIs) using RevMan software. Sensitivity analyses and heterogeneity were quantitatively evaluated.
A total of six randomized controlled trials were included in this analysis. The experimental BEV group had significantly improved the overall PFS (OR =0.46, 95% CI =0.26-0.81, =0.007), as well as PFS at 6 months (OR =3.47, 95% CI =2.85-4.22, <0.00001) and PFS at 12 months (OR =2.02, 95% CI =1.66-2.46, <0.00001), respectively. However, there were no significant differences in PFS at 24 months with BEV (OR =0.95, 95% CI =0.61-1.48, =0.82). OS at 6 months (=0.07) and 24 months (=0.07) was not significantly improved with BEV in patients with newly diagnosed GB. However, the meta-analysis on the OS at 12 months showed differences with BEV (OR =1.24, 95% CI =1.03-1.50, =0.02).
Our study indicates that addition of BEV for newly diagnosed GB resulted in a superior PFS rate. However, the combination therapy involving BEV did not improve OS. Future investigations are needed to analyze whether BEV helps improve OS efficacy.
替莫唑胺（TMZ）与放疗联合以及随后的辅助化疗是胶质母细胞瘤（GB）治疗的金标准。贝伐单抗（BEV）是一种阻断血管内皮生长因子A作用的人源化单克隆抗体，对复发性GB产生了令人印象深刻的缓解率，并已被批准作为二线治疗。BEV在新诊断GB中的疗效和安全性尚不清楚。
进行这项系统的荟萃分析以评估BEV联合治疗在新诊断GB中的价值。
检索电子数据库至2017年10月的合格文献。纳入评估BEV对新诊断GB患者疗效和安全性的随机对照试验，其中主要结局为无进展生存期（PFS）、总生存期（OS）和不良事件（AE）。使用RevMan软件将所有数据与相应的95%置信区间（CI）合并。对敏感性分析和异质性进行定量评估。
本分析共纳入六项随机对照试验。试验性BEV组显著改善了总体PFS（OR = 0.46，95%CI = 0.26 - 0.81，P = 0.007），以及6个月时的PFS（OR = 3.47，95%CI = 2.85 - 4.22，P < 0.00001）和12个月时的PFS（OR = 2.02，95%CI = 1.66 - 2.46，P < 0.00001）。然而，使用BEV时24个月的PFS无显著差异（OR = 0.95，95%CI = 0.61 - 1.48，P = 0.82）。新诊断GB患者使用BEV时，6个月（P = 0.07）和24个月（P = 0.07）的OS未显著改善。然而，对12个月OS的荟萃分析显示使用BEV有差异（OR = 1.24，95%CI = 1.03 - 1.50，P = 0.02）。
我们的研究表明，新诊断GB患者加用BEV可提高PFS率。然而，BEV联合治疗并未改善OS。需要未来的研究来分析BEV是否有助于提高OS疗效。
