Bevacizumab Combined with Chemotherapy for Advanced Non-small Cell Lung Cancer: A meta-analysis

Background and objective Bevacizumab is a recombinant, humanised, monoclonal antibody against the vascular endothelial growth factor receptor (VEGFR), the aim of this meta-analysis is to evaluate the clinical efficacy and safety of bevacizumab combined with chemotherapy for non-small cell lung cancer (NSCLC). Methods The CBM, CNKI, VIP, WanFang, The Cochrane Library, PubMed, Ovid, EMBASE and SCI etc were retrieved by computer, the randomized controlled trials (randomized control trial, RCT) of bevacizumab combined with chemotherapy in the treatment of NSCLC were collected by us. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), toxicities and treatment related mortality. Relative risk (RR) and hazard ratios (HR) were used for the meta-analysis and were expressed with 95% confidence intervals (95%CI), and the software Stata 12.0 was used for meta-analyses. Results Six trials and 2,338 advanced NSCLC patients were included. Meta analysis indicated that compared with chemotherapy alone, the bevacizumab (7.5 mg/kg or 15 mg/kg) combination with chemotherapy could increase overall survival rate (RR=1.68, P<0.01, 95%CI: 1.31-2.15; RR= 1.79, P<0.01, 95%CI: 1.53-2.08), and could decrease the progression of the disease risk (HR=0.75, P<0.01, 95%CI: 0.61-0.89; HR=0.69, P<0.01, 95%CI: 0.62-0.77) and the risk of disease death (HR=0.94, P<0.01, 95%CI: 0.77-1.10; HR=0.87, P<0.01, 95%CI: 0.78-0.97). The high dose of bevacizumab (15 mg/kg) combination with chemotherapy could increase the treatment related mortality (RR=1.88, P=0.010, 95%CI: 1.16-3.05) and the rates of other toxic reaction. Conclusion Whether first-line or second-line treatment, the addition of bevacizumab to chemotherapy in patients with advanced NSCLC prolongs RR, OS and PFS.