Risk of hypertension with bevacizumab, an antibody against vascular endothelial growth factor A: a systematic review and meta-analysis

Abstract

Bevacizumab, a humanized antibody against VEGF, is effective in the treatment of patients with many cancers. However, as with many therapeutic agents, significant side effects are associated with bevacizumab, Hypertension is one of the predominant toxicity. We performed a systematic review and meta-analysis of published clinical trials of bevacizumab to quantify the risk of hypertension. 15 studies following PRISMA guidelines and matching inclusion and exclusion criteria were collected in which a group of patients were either treated with Bevacizumab and a concurrent chemotherapy and another group treated with Placebo and the same chemotherapy. Relative risk (RR) was calculated. P<0.05 was considered statistically significant. RevMan 5.3 software was used for the analysis. A total of 13,070 patients were included. Bevacizumab was associated with a significant increased risk of overall hypertension (RR=3.509; 95% C.I:2.451 to 5.023). 11 trials are included for determining the risk of Grade 3 hypertension including 8799 patients with a significant increased risk (RR=3.909; 95%C.I:1.983 to 7.707). 7 trials are included for determining the risk of hypertension at low dose (2.5 mg/kg/cycle) including 3691 patients associated with a significant increased (RR=2.640; 95%C.I: 1.408 to 4.950). 10 trials are included for determining the risk of hypertension at high dose (5 mg/kg/cycle) including 9379 patients associated with a significant (RR=4.036; 95%C.I: 2.948 to 5.525). Our meta-analysis has demonstrated that bevacizumab may be associated with a significantly increased risk of hypertension in patient with a variety of metastatic solid tumors irrespective of dosing.