Department of Neurology, Dalian Municipal Central Hospital, Dalian, China.
Eur Rev Med Pharmacol Sci. 2022 May;26(10):3522-3533. doi: 10.26355/eurrev_202205_28847.
Glioblastoma (GBM) is the most common and aggressive primary malignant tumor of the central nervous system in adults with high recurrence and mortality rates. Although radiotherapy and temozolomide have become the standard therapeutic regimen for GBM as adjuvant chemoradiotherapy after surgical resection, clinical outcomes remain suboptimal. In recent years, targeted antiangiogenic therapy has attracted considerable attention, but its therapeutic efficacy and safety are still controversial.
Randomized controlled trials (RCTs) of chemoradiotherapy with or without bevacizumab for the treatment of glioblastoma were collected by searching on the Pubmed, Embase, Cochrane, Ovid, Scopus, Web of Science, and Google Scholar databases from the date of database establishment to February 2022. Meta-analysis was performed using RevMan 5.3 software after two investigators independently screened the literature, extracted data, and assessed the risk bias of included studies.
A total of 7 RCTs were included. The meta-analysis showed that bevacizumab in combination with chemoradiotherapy was superior to chemoradiotherapy alone in terms of progression-free survival (PFS), with a statistically significant difference. Interestingly, bevacizumab in combination with chemoradiotherapy improved PFS more significantly in recurrent glioblastoma than in newly diagnosed glioblastoma. However, for overall survival (OS), the combination of bevacizumab with chemoradiotherapy was similar to chemoradiotherapy alone, which was not significantly different. With regard to safety, the incidence of most adverse events was higher in the combination of bevacizumab and chemoradiotherapy than in chemoradiotherapy alone, especially in terms of hematologic adverse events.
Current evidence suggests that angiogenesis inhibitor-containing chemoradiotherapy regimens are preferentially recommended for patients with recurrent glioblastoma to prolong their progression-free survival, provided that safety is acceptable, but this does not confer a significant benefit on overall patient survival.
胶质母细胞瘤（GBM）是成人中枢神经系统最常见和侵袭性的原发性恶性肿瘤，复发率和死亡率高。尽管放疗和替莫唑胺已成为 GBM 的标准治疗方案，作为手术切除后的辅助放化疗，但临床结果仍不理想。近年来，靶向抗血管生成治疗引起了广泛关注，但疗效和安全性仍存在争议。
通过在 Pubmed、Embase、Cochrane、Ovid、Scopus、Web of Science 和 Google Scholar 数据库中搜索，收集了贝伐单抗联合或不联合放化疗治疗胶质母细胞瘤的随机对照试验（RCT）。由两名研究者独立筛选文献、提取数据和评估纳入研究的风险偏倚后，使用 RevMan 5.3 软件进行荟萃分析。
共纳入 7 项 RCT。荟萃分析显示，贝伐单抗联合放化疗在无进展生存期（PFS）方面优于单纯放化疗，差异有统计学意义。有趣的是，贝伐单抗联合放化疗在复发性胶质母细胞瘤中改善 PFS 的效果明显优于新诊断的胶质母细胞瘤。然而，在总生存期（OS）方面，贝伐单抗联合放化疗与单纯放化疗相似，差异无统计学意义。关于安全性，贝伐单抗联合放化疗的大多数不良事件发生率高于单纯放化疗，尤其是血液学不良事件。
目前的证据表明，含有血管生成抑制剂的放化疗方案优先推荐用于复发性胶质母细胞瘤患者，以延长无进展生存期，前提是安全性可以接受，但这对总体患者生存没有显著获益。
