Kim Yu Jin, Lee Hee Min, Lee Ga Eun, Yoo Jin Hui, Lee Hwa Jeong, Rhie Sandy Jeong
College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea.
Graduate School of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea.
Pharmaceuticals (Basel). 2024 Aug 21;17(8):1095. doi: 10.3390/ph17081095.
BACKGROUND/OBJECTIVES: The study aimed to evaluate the efficacy and safety of incorporating bevacizumab into the combination therapy of carboplatin and paclitaxel for epithelial ovarian cancer and other clinical applications.
A systematic review was conducted following PRISMA guidelines using keyword searches in PubMed, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, and ICTRP until February 2024. Randomized controlled trials (RCTs) comparing carboplatin and paclitaxel with and without bevacizumab in ovarian cancer patients were included. Efficacy outcomes were overall survival (OS) and progression-free survival (PFS), as described by hazard ratios (HRs). Safety outcomes were analyzed with risk ratios (RRs) for 16 adverse events.
Seven RCTs (n = 5110) were included. The combination with bevacizumab significantly improved PFS (HR: 0.73; 95% confidence interval: 0.58, 0.92; = 0.008). The chemotherapy group receiving bevacizumab with carboplatin and paclitaxel showed a significantly higher incidence of hypertension, non-CNS bleeding, thromboembolic events, GI perforation, pain, and proteinuria.
The combination of carboplatin, paclitaxel, and bevacizumab improves PFS compared to the regimen without bevacizumab, but it raises significant safety concerns. Clinical management should consider adverse event prevention by vigilantly monitoring blood pressure, signs and symptoms of bleeding, thromboembolism, GI perforation, and pain to balance the therapeutic benefits with the potential risks of this combination therapy.
背景/目的：本研究旨在评估将贝伐单抗纳入卡铂和紫杉醇联合治疗上皮性卵巢癌及其他临床应用中的疗效和安全性。
按照PRISMA指南进行系统评价，在PubMed、Embase、Cochrane图书馆、CINAHL、ClinicalTrials.gov和ICTRP中使用关键词检索，直至2024年2月。纳入比较卡铂和紫杉醇联合或不联合贝伐单抗治疗卵巢癌患者的随机对照试验（RCT）。疗效指标为总生存期（OS）和无进展生存期（PFS），以风险比（HR）描述。安全性指标采用16种不良事件的风险比（RR）进行分析。
纳入7项RCT（n = 5110）。联合贝伐单抗显著改善了PFS（HR：0.73；95%置信区间：0.58，0.92；P = 0.008）。接受贝伐单抗联合卡铂和紫杉醇的化疗组高血压、非中枢神经系统出血、血栓栓塞事件、胃肠道穿孔、疼痛和蛋白尿的发生率显著更高。
与不使用贝伐单抗的方案相比，卡铂、紫杉醇和贝伐单抗联合治疗可改善PFS，但存在重大安全问题。临床管理应通过密切监测血压、出血体征和症状、血栓栓塞、胃肠道穿孔和疼痛来考虑预防不良事件，以平衡这种联合治疗的潜在风险与治疗益处。
