Addition of Bevacizumab to Chemotherapy in Advanced Non-Small Cell Lung Cancer A Systematic Review and Meta-Analysis 英文参考文献.docVIP

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Addition of Bevacizumab to Chemotherapy in Advanced Non-Small Cell Lung Cancer A Systematic Review and Meta-Analysis 英文参考文献.doc

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Addition of Bevacizumab to Chemotherapy in Advanced Non-Small Cell Lung Cancer A Systematic Review and Meta-Analysis 英文参考文献

AdditionofBevacizumabtoChemotherapyinAdvanced Non-SmallCellLungCancer:ASystematicReviewand Meta-Analysis Andre′ BacellarCostaLima1,2,LigiaT.Macedo1,2,Andre′ DeekeSasse1,2 * 1DepartamentodeCl?′nicaMe′dica, FaculdadedeCie?ncias Me′dicas,UniversidadeEstadualdeCampinas(UNICAMP),Campinas,Sa?o Paulo,Brasil,2CentrodeEvide?ncias emOncologia(CEVON),Campinas,Sa?o Paulo,Brasil Abstract Introduction:Recently,studieshavedemonstratedthattheadditionofbevacizumabtochemotherapycouldbeassociated 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 thechemotherapy regimens. Thissystematic review evaluated the strength of dataon efficacyoftheadditionofbevacizumabtochemotherapyinadvancedNSCLC. Methods:PubMed,EMBASE,andCochranedatabasesweresearched.Eligiblestudieswererandomizedclinicaltrials(RCTs) that evaluated chemotherapy with or without bevacizumab in patients with advanced NSCLC. The outcomes included overallsurvival(OS),progression-free survival(PFS),responserate(RR),toxicitiesandtreatmentrelatedmortality.Hazard ratios(HR)andoddsratios(OR)wereusedforthemeta-analysisandwereexpressedwith95%confidenceintervals(CI). Results:WeincludedresultsreportedfromfiveRCTs,withatotalof2,252patientsincludedintheprimaryanalysis,allof themusingplatinum-basedchemotherapyregimens.Comparedtochemotherapyalone,theadditionofbevacizumabto chemotherapyresultedinasignificantlongerOS(HR0.89;95%CI0.79to0.99;p=0.04),longerPFS(HR0.73;95%CI0.66to 0.82;p,0.00001)andhigherresponserates(OR2.34;95%CI1.89to2.89;p,0.00001).Wefoundnoheterogeneitybetween trials, in all comparisons. There was a slight increase in toxicities in bevacizumab group, as well as an increased rate of treatment-relatedmortality. Conclusions:TheadditionofbevacizumabtochemotherapyinpatientswithadvancedNSCLCprolongsOS,PFSandRR. Consideringthetoxicitiesadded,andthesmallabsolutebenefitsfound,bevacizumabplusplatinum-basedchemotherapy canbeconsider