Wang Chuheng, Duan Linan, Zhao Yao, Wang Yubo, Li Yunqian
Neurosurgical Oncology, The First Bethune Hospital of Jilin University, Changchun, China.
Neurosurgical Oncology, The First Bethune Hospital of Jilin University, Changchun, China.
World Neurosurg. 2025 Jan;193:447-460. doi: 10.1016/j.wneu.2024.10.071. Epub 2024 Nov 14.
Glioma is the most common malignant brain tumor in neurosurgery. Bevacizumab (BEV) is a monoclonal antibody that inhibits tumors by inhibiting vascular endothelial growth factor and reducing tumor angiogenesis. To evaluate the efficacy and safety of BEV combined with temozolomide (TMZ) in glioma, we performed a meta-analysis.
PubMed, Embase, The Cochrane Library, and Web of Science databases were searched for randomized controlled trials comparing survival outcomes between TMZ combined with BEV and TMZ alone as well as cohort studies were included in our study. The primary outcome measures analyzed were overall survival (OS) and progression-free survival (PFS).
A total of 6 randomized controlled trials and 4 cohort studies with a total of 2515 patients were included in our meta-analysis. The results of meta-analysis suggested that there were no significant improvements in overall survival, but the combination of TMZ and BEV prolonged progression-free survival, improved overall response rate, and increased the incidence of some adverse reactions, compared with TMZ alone. Subgroup analysis suggested sex, recursive partitioning analysis grade, O-6-methylguanine-DNA methyltransferase gene status and radiotherapy combination did not affect the improvement of OS with the combination of the 2 drugs, and recursive partitioning analysis grade did not affect the improvement of PFS with the combination of the 2 drugs.
The combination of TMZ and BEV can improve PFS as well as overall response rate in patients and has no benefit on OS. At the same time, the adverse reactions during the combination of the 2 drugs were acceptable.
胶质瘤是神经外科最常见的恶性脑肿瘤。贝伐单抗（BEV）是一种单克隆抗体，通过抑制血管内皮生长因子和减少肿瘤血管生成来抑制肿瘤。为评估BEV联合替莫唑胺（TMZ）治疗胶质瘤的疗效和安全性，我们进行了一项荟萃分析。
检索PubMed、Embase、Cochrane图书馆和Web of Science数据库，查找比较TMZ联合BEV与单独使用TMZ的生存结局的随机对照试验以及队列研究纳入我们的研究。分析的主要结局指标为总生存期（OS）和无进展生存期（PFS）。
我们的荟萃分析共纳入6项随机对照试验和4项队列研究，共计2515例患者。荟萃分析结果表明，总生存期无显著改善，但与单独使用TMZ相比，TMZ与BEV联合使用可延长无进展生存期、提高总缓解率并增加一些不良反应的发生率。亚组分析表明，性别、递归划分分析分级、O-6-甲基鸟嘌呤-DNA甲基转移酶基因状态和放疗联合使用并不影响两种药物联合使用对OS的改善，递归划分分析分级也不影响两种药物联合使用对PFS的改善。
TMZ与BEV联合使用可改善患者的PFS以及总缓解率，对OS无益处。同时，两种药物联合使用期间的不良反应是可接受的。
