A Meta-Analysis Of The Efficacy And Safety Of Bevacizumab In The Maintenance Of Advanced Colorectal Cancer

Objective:To evaluate the efficacy and safety of bevacizumab-based maintenance therapy after first-line chemotherapy for metastatic colorectal cancer(mCRC).Methods: We conducted a meta-analysis of randomized controlled trials comparing bevacizumab-based maintenance therapy,observation,and original regimen maintenance chemotherapy.We searched the PubMed,Embase,and Cochrane databases for relevant articles published through March 2018.All randomized phase-III trials evaluating bevacizumab-based maintenance treatment were eligible for inclusion.The primary and secondary endpoints were progression-free survival(PFS)and overall survival(OS),respectively.Hazard ratios(HRs)with 95% confidence intervals(CIs)or data for calculating HRs with 95% CIs were extracted.The RevMan v5.3 software was used for data analysis.Results: Nine trials(3121 patients)were included in this meta-analysis.Compared to observation alone,bevacizumab-based maintenance therapy significantly improved PFS(HR: 0.62,95% CI:0.47–0.82)and showed a trend toward prolonged OS(HR: 0.93,95% CI:0.83–1.05).The incidence of grade 3/4 toxicity,including hypertension and fatigue,was higher after maintenance therapy than after observation alone.PFS(HR: 0.91,95% CI: 0.70–1.18)and OS(HR: 0.88,95% CI: 0.74–1.04)did not differ between the maintenance therapy and original regimen maintenance chemotherapy groups.Grade 3/4 toxicity,including diarrhea and sensory neuropathy,was less common after maintenance therapy than after original regimen maintenance chemotherapy.Conclusion: Bevacizumab-based maintenance therapy significantly improved PFS,showed a trend toward prolonged OS,and reduced cumulative grade 3/4 toxicity relative to original regimen maintenance chemotherapy with comparable efficacy.Although maintenance therapy was beneficial,the optimal strategy should be individualized.