Addition of bevacizumab to chemotherapy in patients with ovarian cancer: a systematic review and meta-analysis of randomized trials

This systematic review and meta-analysis analyzed randomized controlled trials (RCTs) assessing the efficacy and tolerance of incorporating bevacizumab into chemotherapy in patients with advanced ovarian cancer. MEDLINE, Web of Science, EMBASE and the Cochrane Central Register of Controlled Trials were reviewed for RCTs evaluating add-on bevacizumab in advanced ovarian cancer. Progression-free survival (PFS), overall survival (OS), objective response rate and adverse events were obtained from RCTs comparing first- and second-line bevacizumab plus chemotherapy with chemotherapy alone for advanced ovarian cancer. Meta-analyses were performed to determine hazard ratios for time-to-event variables and odds ratios for dichotomous outcomes using random-effects or fixed-effects model based on the heterogeneity of included studies. Four RCTs, including 4246 patients, were identified and analyzed. Two trials, GOG218 and ICON7, assessing bevacizumab in first-line chemotherapy, found that bevacizumab significantly extended PFS (HR 0.82; 95 % CI 0.75-0.89) and OS (HR 0.86; 95 % CI 0.75-0.99). The other two trials, OCEANS and AURELIA, analyzing second-line bevacizumab, found that this agent extended PFS (HR 0.48; 95 % CI 0.41-0.57), but did not enhance OS (HR 0.93; 95 % CI 0.78-1.12). The most common adverse events associated with bevacizumab included hypertension, proteinuria and gastrointestinal perforation. The addition of bevacizumab to chemotherapy followed by bevacizumab significantly improved PFS and OS in frontline setting and PFS in recurrent settings compared with that of chemotherapy alone in patients with advanced ovarian cancer.