Addition of bevacizumab to chemotherapy in advanced non-small cell lung cancer: a systematic review and meta-analysis
Open accessAbstract
INTRODUCTION: Recently, studies have demonstrated that the addition of bevacizumab to chemotherapy could be associated with better outcomes in patients with advanced non-small cell lung cancer (NSCLC). However, the benefit seems to be dependent on the drugs used in the chemotherapy regimens. This systematic review evaluated the strength of data on efficacy of the addition of bevacizumab to chemotherapy in advanced NSCLC. METHODS: PubMed, EMBASE, and Cochrane databases were searched. Eligible studies were randomized clinical trials (RCTs) that evaluated chemotherapy with or without bevacizumab in patients with advanced NSCLC. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), toxicities and treatment related mortality. Hazard ratios (HR) and odds ratios (OR) were used for the meta-analysis and were expressed with 95% confidence intervals (CI). RESULTS: We included results reported from five RCTs, with a total of 2,252 patients included in the primary analysis, all of them using platinum-based chemotherapy regimens. Compared to chemotherapy alone, the addition of bevacizumab to chemotherapy resulted in a significant longer OS (HR 0.89; 95% CI 0.79 to 0.99; p = 0.04), longer PFS (HR 0.73; 95% CI 0.66 to 0.82; p<0.00001) and higher response rates (OR 2.34; 95% CI 1.89 to 2.89; p<0.00001). We found no heterogeneity between trials, in all comparisons. There was a slight increase in toxicities in bevacizumab group, as well as an increased rate of treatment-related mortality. CONCLUSIONS: The addition of bevacizumab to chemotherapy in patients with advanced NSCLC prolongs OS, PFS and RR. Considering the toxicities added, and the small absolute benefits found, bevacizumab plus platinum-based chemotherapy can be considered an option in selected patients with advanced NSCLC. However, risks and benefits should be discussed with patients before decision making.
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Two meta-analyses showed a consistent significant improvement of response rate, progression-free survival, and overall survival for the combination of bevacizumab and platinum-based chemotherapy compared with platinum-based chemotherapy alone in eligible patients with non-squamous NSCLC.
“two meta-analyses showed a consistent significant improvement of RR, PFS and OS for the combination of bevacizumab and platinum-based chemotherapy, compared with platinum-based chemotherapy alone in eligible patients with NSCC [61,62].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [61]
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- Authors
- Lima, A. B. C., Macedo, L. T., & Sasse, A. D.
- Affiliations
- Universidade Estadual de Campinas (UNICAMP) (BR)
- Corresponding author
- Sasse, André Deeke
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-08-02
- Volume
- 6
- Issue
- 8
- Pages
- e22681
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3149053
- OpenAlex
- W2132000516
- Cited by
- 92
- References
- 41
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 8 · 2018: 5 · 2017: 6 · 2016: 4 · 2015: 7 · 2014: 10 · 2013: 14 · 2012: 5
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion, cc-by)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- bevacizumab, non-small cell lung cancer, advanced non-small cell lung cancer, platinum-based chemotherapy, combination therapy, overall survival, progression-free survival, response rate, non-relapse mortality, chemotherapy toxicity, anti-VEGF therapy
- MeSH terms
- Bevacizumab, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Survival Analysis, Randomized Controlled Trials as Topic, Antibodies, Monoclonal, Humanized
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