Objective:
This systematic review and meta-analysis aims to evaluate the efficacy and safety of bevacizumab in patients with ovarian cancer over a shorter and longer follow-up period.
Methods:
We searched Medline, Cochrane CENTRAL, Scopus, and Google Scholar for all phase 3 randomized controlled trials (RCTs) that administered bevacizumab to women with ovarian cancer. Review Manager 5.4 was used to calculate risk ratios (RR) and hazard ratios (HR) with 95% CIs. We assessed the quality of the included studies using version 2 of the Cochrane Risk of Bias tool (RoB 2).
Results:
After screening the titles, abstracts, and full texts, we included nine RCTs in our systematic review and meta-analysis. Four RCTs had a low risk of bias, while 5 had some concerns. Bevacizumab was associated with a progression free survival benefit for <36 months (HR: 0.59, 95% CI: 0.45-0.76, P36 months (HR: 0.66, 95% CI: 0.55-0.80, P<0.0001, I2=80%), and an overall survival benefit for 36 months (HR: 0.98, 95% CI: 0.89-1.09, P=0.77, I2=30%). There was no difference in deaths between intervention and control groups 36 months (RR: 1.02, 95% CI: 0.97-1.06, P=0.50, I2=0%). Bevacizumab reduced disease progression 36 months (RR: 0.83, 95% CI: 0.58-1.19, P=0.30, I2=94%). The adverse events reported with Bevacizumab use included thrombocytopenia, neutropenia, leukocytopenia, anemia, hypertension, bleeding or hemorrhage, and gastrointestinal, cardiac, and dermatological adverse events.
Conclusion:
Bevacizumab may improve progression-free survival within and after 36 months, overall survival within 36 months, and reduce disease progression within 36 months.