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Background: Angiogenesis contributes to the progression of breast cancer and vascular endothelial growth factor (VEGF) plays an essential role in neovascularization. Bevacizumab, as a humanized recombinant monoclonal antibody,specifically targets the VEGF receptors. Manifold data have demonstrated that the addition of bevacizumab to chemotherapy improved progression-free survival (PFS), while none of the trials revealed its significant survival benefit. Furthermore, it still remains suspended how to maximize the benefits of bevacizumab and minimize its risks in the metastatic setting.
Objectives: We sought to conduct a meta-analysis to assess the benefits of bevacizumab with chemotherapy as well as to identify the best partner of bevacizumab in the treatment of metastatic breast cancer patients.?
Methods: Computerized and manual searches were performed to identify randomized clinical trials comparing salvage chemotherapy with or without bevacizumab in metastatic breast cancer patients. Hazard ratios (HR) and risk ratios (RR) with their 95% confidence intervals (CIs) were used to estimate the association between the addition of bevacizumab to salvage chemotherapy and various survival outcomes. The fixed effects or random-effects model was used to combine data. Primary outcomes were objective response rate (ORR), PFS and overall survival (OS).
Results: With five trials identified, this analysis included 3,544 eligible patients. The addition of bevacizumab to salvage chemotherapy resulted in a statistically significant improvement in PFS (HR = 0.73, 95% CI=0.64-0.83, P<0.001) and ORR (RR = 1.464, 95% CI=1.324-1.618, P<0.001) rather than OS (HR = 0.92, 95%CI=0.82-1.04, P=0.191) when compared with chemotherapy alone. Subgroup analysis further verified that PFS advantages were merely discerned for taxanes/anthracyclines and first-line chemotherapy.
Conclusion: This meta-analysis reveals that the addition of bevacizumab to chemotherapy yielded PFS benefit in patients with metastatic breast cancer. Bevacizumab treatment might be recommended in combination with taxanes/anthracyclines and for first-line treatment in the metastatic setting. |
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| Keywords:metastatic breast cancer; bevacizumab; meta-analysis |
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