The role of bevacizumab in targeted vascular endothelial growth factor therapy for epithelial ovarian cancer: an updated systematic review and meta-analysis

Abstract

The impact of bevacizumab (an anti-vascular endothelial growth factor therapy) remains uncertain, which has been the focus of studies on the management of epithelial ovarian cancer (EOC). To investigate the efficacy of bevacizumab combinations with different regimens in the treatment of patients with EOC, a meta-analysis of Phase III randomized controlled trials was conducted. The databases searched included PubMed, Embase, ClinicalTrials.gov, Chinese Knowledge Infrastructure, as well as the Cochrane Central Register of Controlled Trials. After evaluation of quality, a meta-analysis of valid extracted data was performed using Review Manager (RevMan) software. Five studies with 4,369 patients were included. Bevacizumab plus chemotherapy improved progression-free survival (hazard ratio [HR] =0.63; 95% confidence interval [CI], 0.51–0.77; P<0.01) and overall survival (HR =0.91; 95% CI, 0.84–0.99; P<0.05). Interestingly, in patients with a high risk of progression, the subgroups that received bevacizumab combined with different regimens of chemotherapy showed a significant improvement with paclitaxel plus carboplatin-based chemotherapy (HR =0.86; 95% CI, 0.77–0.95; P<0.01), but not with non-paclitaxel plus carboplatin-based chemotherapy (HR =0.91; 95% CI, 0.77–1.07; P>0.05) in overall survival. The combination of bevacizumab and paclitaxel plus carboplatin-based regimens offers a new treatment option for women with EOC, especially in those with a high risk of progression.

Current Ovarian Cancer Maintenance Strategies and Promising New Developments

“…Another meta-analysis by Ruan et al, demonstrated an improvement in PFS (HR 0.63; p=<0.01), and OS (HR 0.91 p=<0.05). These pooled results suggest an OS benefit for bevacizumab treatment in the maintenance setting, but at a level that would be of impact in very few patients given the HR of 0.91 54 .…”

Anti-angiogenesis treatment in a patient with appendix metastasis of small cell lung cancer

“…Bevacizumab, a human monoclonal antibody against VEGF, is currently used to treat tumors such as lung adenocarcinoma, [22] colorectal cancer, [23] and ovarian cancer. [24] However, clinical trials of bevacizumab for treating SCLC revealed that the treatment did not prolong survival. The ECOG3501 trial validated the efficacy and safety of the combination of IP and bevacizumab.…”

Ovarian cancer: new strategies and emerging targets for the treatment of patients with advanced disease

“…5 Consistent ly, VEGF inhibition by bevacizumab in combination with chemotherapy, followed by maintenance therapy, has proven effective in delaying disease progression in ovarian cancer when administered after initial surgical resection or in recurrent platinumsensitive disease, and as monotherapy or combined with chemotherapy in patients with platinum-resistant disease. [6][7][8] However, various mechanisms may allow escape of tumor cells from therapeutic control, including selection of tumor clones with increased expression of compensatory signaling pathways or clones with an increased capacity to grow and invade normal tissues in conditions of limited angiogenic support. 9,10 Multiple approaches are thus being investigated to further improve clinical outcomes, through the development and characterization of novel antiangiogenic agents, and their use in combination regimens with agents targeting other key pathways in tumor cells (i.e.…”