Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Neurosurg Rev. 2024 Aug 20;47(1):445. doi: 10.1007/s10143-024-02667-8.
Bevacizumab, temozolomide (TMZ), and radiotherapy are three therapeutic methods, but the combination of them as a new approach for the treatment of newly diagnosed high-grade gliomas (HGGs) is still under investigation. Therefore, this study aims to evaluate the safety, efficacy, and clinical utility of this treatment approach for patients with glioblastoma (GBM). PubMed/Medline, Scopus, Embase, and Web of Science were systematically reviewed from inception to 24 August 2023. Relevant studies evaluating the therapeutic effect of adding Bevacizumab to TMZ-based chemotherapy and radiation therapy were enrolled. All statistical analysis was performed using the "meta" package of R. A total of 21 studies were included in this study. Our meta-analysis found that adding bevacizumab to standard therapy improved progression-free survival (PFS) in patients with newly diagnosed GBM. The pooled 6-month PFS rate was significantly higher with bevacizumab (79% vs. 56%, odds ratio 3.17). Overall survival (OS) showed modest improvements, with 2-year OS rates of 39% vs. 20% favoring bevacizumab. Radiological response rates varied, with a pooled overall response rate of 44% for bevacizumab-treated patients. The complete response rate was 16%, partial response 32%, and progressive disease 25%. Adverse events occurred in 62% of bevacizumab-treated patients. Common complications included fatigue, thrombocytopenia, and thromboembolic events. When added to standard therapy, bevacizumab demonstrates modest improvements in PFS and OS for newly diagnosedGBM. While it shows promise in short-term outcomes and radiological responses, long-term survival benefits remain limited. The risk of adverse events, particularly CNS hemorrhage, necessitates careful patient selection. These findings suggest that bevacizumab may have a role in treating high-grade gliomas, but its use should be individualized based on patient characteristics and risk-benefit assessment.
贝伐珠单抗、替莫唑胺（TMZ）和放疗是三种治疗方法，但将它们联合作为新方法治疗新诊断的高级别脑胶质瘤（HGGs）仍在研究中。因此，本研究旨在评估这种治疗方法对胶质母细胞瘤（GBM）患者的安全性、疗效和临床应用价值。我们系统地检索了 PubMed/Medline、Scopus、Embase 和 Web of Science 数据库，检索时间从建库至 2023 年 8 月 24 日。纳入评估贝伐珠单抗联合 TMZ 化疗和放疗治疗效果的相关研究。所有统计分析均使用 R 语言的“meta”包进行。共有 21 项研究纳入本研究。我们的荟萃分析发现，在标准治疗的基础上加用贝伐珠单抗可改善新诊断 GBM 患者的无进展生存期（PFS）。贝伐珠单抗组的 6 个月 PFS 率显著更高（79% vs. 56%，比值比 3.17）。总生存期（OS）有适度改善，贝伐珠单抗组的 2 年 OS 率为 39%，而对照组为 20%。影像学反应率不一，贝伐珠单抗组的总体反应率为 44%，其中完全缓解率为 16%，部分缓解率为 32%，疾病进展率为 25%。贝伐珠单抗组有 62%的患者发生不良事件。常见的并发症包括疲劳、血小板减少和血栓栓塞事件。贝伐珠单抗联合标准治疗可改善新诊断 GBM 的 PFS 和 OS，但长期生存获益有限。不良反应发生率较高，尤其是中枢神经系统出血，需要仔细选择患者。这些发现表明，贝伐珠单抗可能在治疗高级别脑胶质瘤中发挥作用，但应根据患者特征和风险效益评估进行个体化应用。
