Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 5072-5080
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.5072
Value of bevacizumab in treatment of colorectal cancer: A meta-analysis
Chun-Ying Qu, Ying Zheng, Min Zhou, Yi Zhang, Feng Shen, Jia Cao, Lei-Ming Xu
Chun-Ying Qu, Min Zhou, Yi Zhang, Feng Shen, Jia Cao, Lei-Ming Xu, Department of Digestive Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Chun-Ying Qu, Min Zhou, Yi Zhang, Feng Shen, Jia Cao, Lei-Ming Xu, Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai Institute of Pediatric Research, Shanghai 200092, China
Ying Zheng, Department of Oncology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200081, China
Author contributions: Xu LM and Qu CY contributed to study conception and design; Zhou M, Zhang Y, Shen F and Cao J were responsible for acquisition and analysis of the data; Qu CY and Zheng Y drafted and revised the article; Xu LM gave the final approval of the version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lei-Ming Xu, Chief Physician, Department of Digestive Diseases, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China. leiming.xu@aliyun.com
Telephone: +86-21-25077120 Fax: +86-21-25077120
Received: August 15, 2014
Peer-review started: August 15, 2014
First decision: September 15, 2014
Revised: September 30, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: April 28, 2015
Processing time: 254 Days and 16.8 Hours
Abstract

AIM: To assess the efficacy and safety of bevacizumab in the treatment of colorectal cancer.

METHODS: All randomized controlled trials of bevacizumab for the treatment of colorectal cancer from January 2003 to June 2013 were collected by searching the Cochrane Library, PubMed, Chinese National Knowledge Infrastructure and Wanfang databases. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival, overall response rate and adverse events. Two reviewers extracted data independently. Statistical analyses were performed with Stata 12.0. The degree of bias was assessed using funnel plots for the effect size of OS at the primary endpoint.

RESULTS: Following the inclusion criteria and exclusion criteria, ten studies comprising 6977 cases were finally included, of which nine were considered to be of high quality (4-7 points) and one of low quality (1-3 points). Our meta-analysis revealed the efficacy of bevacizumab in patients with colorectal cancer in terms of OS (HR = 0.848, 95%CI: 0.747-0.963), progression-free survival (HR = 0.617, 95%CI: 0.530-0.719), and overall response rate (OR = 1.627, 95%CI: 1.199-2.207). Regarding safety, higher rates of grade ≥ 3 hypertension, proteinuria, bleeding, thrombosis, and gastrointestinal perforation were observed in the bevacizumab treatment group (P < 0.05); however, the incidence of serious toxicity was very low. There was no publication bias in the 10 reports included in this meta-analysis.

CONCLUSION: The clinical application of bevacizumab in colorectal cancer is effective with good safety.

Keywords: Bevacizumab; Colorectal cancer; Clinical application; Randomized controlled trials; Meta-analysis

Core tip: Bevacizumab combined with chemotherapy can provide a significant survival advantage in patients with colorectal cancer. Despite the increased risk of hypertension, proteinuria, bleeding, thrombosis, gastrointestinal perforation and other adverse events, bevacizumab combined with chemotherapy deserves further promotion in future clinical work due to its low incidence of serious adverse events, excellent overall tolerance and good safety.