The prognosis for patients with newly diagnosed glioblastoma receiving bevacizumab combination therapy: a meta-analysis

Abstract

BackgroundA combination of temozolomide (TMZ) and radiotherapy and subsequent adjuvant chemotherapy is the gold standard of treatment for glioblastoma (GB). Bevacizumab (BEV), a humanized monoclonal antibody that blocks the effects of vascular endothelial growth factor A, has produced impressive response rates for recurrent GB and has been approved as second-line therapy. The efficacy and safety of BEV in newly diagnosed GB are not known.AimThis systematic meta-analysis was undertaken to evaluate the value of combination therapy involving BEV in newly diagnosed GB.MethodsElectronic databases were searched for eligible literature up to October 2017. Randomized controlled trials assessing the efficacy and safety of BEV in patients with newly diagnosed GB were included, of which the main outcomes were progression-free survival (PFS), overall survival (OS), and adverse events (AEs). All the data were pooled with the corresponding 95% confidence intervals (CIs) using RevMan software. Sensitivity analyses and heterogeneity were quantitatively evaluated.ResultsA total of six randomized controlled trials were included in this analysis. The experimental BEV group had significantly improved the overall PFS (OR =0.46, 95% CI =0.26–0.81, P=0.007), as well as PFS at 6 months (OR =3.47, 95% CI =2.85–4.22, P<0.00001) and PFS at 12 months (OR =2.02, 95% CI =1.66–2.46, P<0.00001), respectively. However, there were no significant differences in PFS at 24 months with BEV (OR =0.95, 95% CI =0.61–1.48, P=0.82). OS at 6 months (P=0.07) and 24 months (P=0.07) was not significantly improved with BEV in patients with newly diagnosed GB. However, the meta-analysis on the OS at 12 months showed differences with BEV (OR =1.24, 95% CI =1.03–1.50, P=0.02).ConclusionOur study indicates that addition of BEV for newly diagnosed GB resulted in a superior PFS rate. However, the combination therapy involving BEV did not improve OS. Future investigations are needed to analyze whether BEV helps improve OS efficacy.

Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

“…The study of Li et al 27 showed that the PFS time at 24 months and 36 months in the BEV group was lower than that in the non-BEV group. The results of Liao et al 28 showed that a higher incidence of PFS could be obtained by adding BEV to newly diagnosed Glioblastoma (GB), and this combined treatment did not improve OS. The AVA glio 29 trial showed that patients treated with BEV had significant advantages in PFS (6.2 months vs 10.6 months) and maintenance of life quality, but showed no advantages in OS (16.8 months vs 16.7 months).…”

Boswellic acid has anti‐inflammatory effects and enhances the anticancer activities of Temozolomide and Afatinib, an irreversible ErbB family blocker, in human glioblastoma cells

“…Glioblastoma multiforme (GBM) is a highly malignant primary tumor of the central nervous system, accounting for approximately 12–15% of all brain tumors (Davis, ). The current standard therapy is Temozolomide (TMZ) associated to radiotherapy (Liao, Huang, & Wu, ). Furthermore, development of the genomic technology leads to the identification of markers able to manage the proper therapeutic strategy.…”

Co-Administered Polymeric Nano-Antidotes for Improved Photo-Triggered Response in Glioblastoma

“…Combination therapy has been used across various cancer types in an effort to reduce the likelihood of multidrug resistance from efflux pumps and P-glycoproteins in the cell membrane of cancer cells, for example [29,30,31,32,33]. The tumor microenvironment is characterized by acidic pH, hypoxia and increased interstitial pressure, all of which promote the heterogeneous cell populations which are resistant, quickly adapting and mutating [34,35].…”