Efficacy and safety of bevacizumab combined with temozolomide in the treatment of glioma a systematic review and meta-analysis of clinical trials.

in World neurosurgery by Chuheng Wang, Linan Duan, Yao Zhao, Yubo Wang, Yunqian Li

TLDR

  • The study looked at how well a combination of two drugs (BEV and TMZ) worked in treating a type of brain tumor called glioma. The study found that the combination of the two drugs improved how long patients lived without their tumor getting worse (PFS) and how many patients' tumors shrank (ORR). However, the study also found that the combination of the two drugs did not improve how long patients lived overall (OS). The study also looked at how different patient characteristics, like age and tumor size, affected how well the combination therapy worked. The study suggests that the combination therapy may be helpful for some patients, but more research is needed to understand how well it works and how safe it is.

Abstract

Glioma is the most common malignant brain tumor in neurosurgery. Bevacizumab (BEV) is a monoclonal antibody that inhibits tumors by inhibiting vascular endothelial growth factor and reducing tumor angiogenesis. To evaluate the efficacy and safety of BEV combined with temozolomide (TMZ) in glioma, we performed a meta-analysis. PubMed, Embase, The Cochrane Library, and Web of Science databases were searched for randomized controlled trials comparing survival outcomes between TMZ combined with BEV and TMZ alone as well as cohort studies were included in our study. The primary outcome measures analyzed were overall survival (OS) and progression-free survival (PFS). A total of six randomized controlled trials and four cohort studies with a total of 2515 patients were included in our meta-analysis. The results of meta-analysis suggested that there were no significant improvements in overall survival, but the combination of TMZ and BEV prolonged progression-free survival, improved overall response rate (ORR), and increased the incidence of some adverse reactions, compared with TMZ alone. Subgroup analysis suggested sex, recursive partitioning analysis (RPA) grade, MGMT gene status and radiotherapy combination did not affect the improvement of OS with the combination of the two drugs, and RPA grade did not affect the improvement of PFS with the combination of the two drugs. The combination of TMZ and BEV can improve PFS as well as ORR in patients and has no benefit on OS. At the same time, the adverse reactions during the combination of the two drugs were acceptable.

Overview

  • The study evaluates the efficacy and safety of bevacizumab (BEV) combined with temozolomide (TMZ) in glioma patients. The hypothesis being tested is whether the combination of BEV and TMZ improves overall survival (OS) and progression-free survival (PFS) compared to TMZ alone. The methodology used for the experiment includes a meta-analysis of randomized controlled trials and cohort studies. The primary objective of the study is to determine the impact of the combination of BEV and TMZ on OS and PFS in glioma patients. The study aims to answer the question: Does the combination of BEV and TMZ improve PFS and OS in glioma patients?

Comparative Analysis & Findings

  • The meta-analysis results suggest that there were no significant improvements in overall survival, but the combination of TMZ and BEV prolonged progression-free survival, improved overall response rate (ORR), and increased the incidence of some adverse reactions, compared with TMZ alone. Subgroup analysis suggests that sex, recursive partitioning analysis (RPA) grade, MGMT gene status and radiotherapy combination did not affect the improvement of OS with the combination of the two drugs, and RPA grade did not affect the improvement of PFS with the combination of the two drugs. The combination of TMZ and BEV can improve PFS as well as ORR in patients and has no benefit on OS.

Implications and Future Directions

  • The study's findings suggest that the combination of BEV and TMZ can improve PFS and ORR in glioma patients. However, the combination does not improve overall survival. The study highlights the importance of considering individual patient characteristics, such as RPA grade and MGMT gene status, when determining the efficacy of the combination therapy. Future research should focus on identifying the optimal combination therapy and patient subgroups that may benefit the most from this approach. Additionally, further studies are needed to evaluate the long-term safety and efficacy of the combination therapy in glioma patients.
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