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. 2021 Jan;14(1):100964.
doi: 10.1016/j.tranon.2020.100964. Epub 2020 Nov 25.

The efficacy and safety of adding bevacizumab in neoadjuvant therapy for locally advanced rectal cancer patients: A systematic review and meta-analysis

Yue Zhou  1 , Zhexu Guo  2 , Zhonghua Wu  2 , Jinxin Shi  2 , Cen Zhou  2 , Jie Sun  2 , Iko Hidasa  2 , Xuefei Lu  3 , Chong Lu  4
Affiliations

The efficacy and safety of adding bevacizumab in neoadjuvant therapy for locally advanced rectal cancer patients: A systematic review and meta-analysis

Yue Zhou et al. Transl Oncol. 2021 Jan.

Abstract

Background: Patients with locally advanced rectal cancer (LARC) are more likely to suffer local recurrence and distant metastases, contributing to worse prognoses. Considering the provided dramatic reduction of local recurrences, neoadjuvant CRT (nCRT) followed by curative resection with total mesorectal excision (TME) and adjuvant chemotherapy has been established as standard therapy for LARC patients. However, the efficacy of adding bevacizumab in neoadjuvant therapy, especially in induction therapy-containing nCRT for LARC patients remains uncertain.

Materials: PubMed, Embase, and Web of Science were searched to retrieve records on the application of bevacizumab in a neoadjuvant setting for LARC patients. The endpoints of interest were pCR and the rates of patients suffering Grade 3/4 bevacizumab-specific adverse events, namely bleeding, wound healing complications, and gastrointestinal perforation.

Results: 29 cohorts covering 1134 subjects were included in this systematic review. The pooled pCR rate for bevacizumab-relevant cohorts was 21% (95% confidence interval (95% CI), 17-25%; I2 = 61.8%), the pooled estimates of Grade 3/4 bleeding, Grade 3/4 wound healing complication, Grade 3/4 gastrointestinal perforation were 1% (95% CI, 0-3%; I2 = 0%), 2% (95% CI, 1-5%; I2 = 4.7%), and 2% (95% CI, 0-5%; I2 = 0%), respectively.

Conclusion: The addition of bevacizumab in the nCRT, especially in the TNT, for LARC patients provides promising efficacy and acceptable safety. However, the results should be interpreted cautiously due to the small amount of relevant data and need further confirmation by future studies.

Keywords: Bevacizumab; Induction therapy; Locally advanced rectal cancer; Neoadjuvant chemoradiotherapy; VEGF-inhibitor.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Literature search and study selection.
Fig. 2
Fig. 2
The forest plot of pooled estimate of pCR (sub-grouped by backbone therapy).
Fig. 3
Fig. 3
The forest plot of pooled estimate of pCR (sub-grouped by region).
Fig. 4
Fig. 4
The forest plot of pooled estimate of pCR (sub-grouped by CRT or chemotherapy).
Fig. 5
Fig. 5
A, the forest plot of pooled estimate of Grade 3/4 bleeding; B, the forest plot of pooled estimate of Grade 3/4 wound healing complications; C, the forest plot of pooled estimate of Grade 3/4 gastrointestinal perforation.
See this image and copyright information in PMC

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