Efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Zhaoyan , TIAN Fangyuan , ZHAN Mei ,  XU Ting

Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

XU Ting, Email: tingx2009@163.com

Keywords：

Bevacizumab; STUPP regimen; Glioblastoma; Randomized controlled trials; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.201710122

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ObjectivesTo systematically review the efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma.MethodsPubMed, EMbase, the Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were searched to obtain randomized controlled trials (RCTs) of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma patients from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 6 RCTs involving 2 835 patients were included. The results of meta-analysis showed that: the bevacizumab combined with STUPP regimen group was superior to the control group on PFS (HR=0.69, 95%CI 0.62 to 0.77, P<0.000 01). But the adverse events rate at the three and above three levels was significantly higher than the control group (P<0.05).ConclusionsCurrent evidence shows that bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma can significantly prolong the PFS. The treatment group performs not as well as the control group on adverse event rate. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： CHEN Zhaoyan, TIAN Fangyuan, ZHAN Mei, XU Ting. Efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(5): 470-475. doi: 10.7507/1672-2531.201710122 Copy

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8.	Chinot O, Wick W, Mason W, et al. Bevacizumab plus radiotherapy–temozolomide for newly diagnosed glioblastoma. N Engl J Med, 2014, 370(8): 709-722.
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10.	陈婵娟, 王家祺, 梁永, 等. 替莫唑胺联合贝伐单抗同步放疗对高级别脑胶质瘤术后患者的疗效分析. 肿瘤药学, 2015, 2(5), 126-129.
11.	Mike M, Matsuo Y, Yoshida S, et al. A case of locally advanced and metastatic breast cancer successfully treated with combination therapy of paclitaxel and bevacizumab. Gan To Kagaku Ryoho, 2014, 41(8): 1027-1029.
12.	Taal W, Oosterkamp HM, Walenkamp AM, et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase II trial. Lancet Oncol, 2014, 15 (9): 943-953.
13.	Cooke VG, Lebleu VS, Keskin D, et al. Pericyte depletion results in hypoxia-associated epithelial-to-mesenchymal transition and metastasis mediated by met signaling pathway. Cancer Cell, 2012, 21(1): 66-81.
14.	Bergers G, Hanahan D. Modes of resistance to anti-angiogenic therapy. Nat Rev Cancer, 2008, 8(8): 592-603.

1. Ostrom QT, Gittleman H, Fulop J, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the united states in 2008-2012. Neuro Oncol, 2015, 17(4): 1-62.
2. KerbelR S. Tumor angiogenesis. N Engl J Med, 2008, 358(19): 2039-2049.
3. 赵思任, 李仙锋. 高级别胶质瘤诊断及治疗进展. 中国综合临床, 2017, 7(32): 670-672.
4. 《中国中枢神经系统胶质瘤诊断和治疗指南》编写组. 中国中枢神经系统胶质瘤诊断与治疗指南(2015). 2016, 7(96): 485-509.
5. Balana C, Penas R, Manuel J, et al. Bevacizumab and temozolomide versus temozolomide alone as neoadjuvant treatment in unresected glioblastoma: the GENOM 009 randomized phase II trial. J Neurooncol, 2016, 127(3): 569-579.
6. Saran F, Chinot O, Henriksson R, et al. Bevacizumab, temozolomide, and radiotherapy for newly diagnosed glioblastoma: comprehensive safety results during and after first-line therapy. Neuro Oncol, 2016, 18(7): 991-1001.
7. Gilbert M, Dignam J, Armstrong T, et al. A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med, 2014, 370(8): 699-708.
8. Chinot O, Wick W, Mason W, et al. Bevacizumab plus radiotherapy–temozolomide for newly diagnosed glioblastoma. N Engl J Med, 2014, 370(8): 709-722.
9. Lai A, Tran A, Phioanh L, et al. Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme. J Clin Oncol, 2011, 29(2): 142-148.
10. 陈婵娟, 王家祺, 梁永, 等. 替莫唑胺联合贝伐单抗同步放疗对高级别脑胶质瘤术后患者的疗效分析. 肿瘤药学, 2015, 2(5), 126-129.
11. Mike M, Matsuo Y, Yoshida S, et al. A case of locally advanced and metastatic breast cancer successfully treated with combination therapy of paclitaxel and bevacizumab. Gan To Kagaku Ryoho, 2014, 41(8): 1027-1029.
12. Taal W, Oosterkamp HM, Walenkamp AM, et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase II trial. Lancet Oncol, 2014, 15 (9): 943-953.
13. Cooke VG, Lebleu VS, Keskin D, et al. Pericyte depletion results in hypoxia-associated epithelial-to-mesenchymal transition and metastasis mediated by met signaling pathway. Cancer Cell, 2012, 21(1): 66-81.
14. Bergers G, Hanahan D. Modes of resistance to anti-angiogenic therapy. Nat Rev Cancer, 2008, 8(8): 592-603.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma: a meta-analysis

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