The Efficacy And Safety Of Bevacizumab Combined With Chemotherapy In Elderly Patients With Non Small Cell Lung Cancer:A Meta Analysis And Systematic Review

Background: Lung cancer has become the leading cause of cancer-related death in China,of which more than 80% is non-small-cell-lung cancer(NSCLC).However,the current chemotherapy regimen has been at a bottleneck,and patients with NSCLC can not benefit from it.Therefore,developing new antitumor drugs has become an urgent clinical need.Bevazumab(Bevacizumab,Bev),which has been listed as a first-line regimen for advanced NSCLC,has not been reached consensus on the efficacy and safety of elderly patients with age of more than 65 years.In this study,the published literature on senile NSCLC patients undergoing bevacizumab therapy combined with chemotherapy was explored to investigate whether the combination of bevacizumab and chemotherapy regimen improved the outcome and prognosis of patients as well as assess the safety of bevacizumab,providing clinical medication basis for the elderly NSCLC patients.Methods: The databases of PubMed,Embase,Cochrane Library,CNKI,and Wanfang were searched online.Non small cell lung cancer,Bevazicumab/Avastin and nonlung-cancer/NSCLC "as the key words were used to collect the domestic and foreign published literature about bevacizumab combined with chemotherapy in the treatment of elderly patients with NSCLC.Two researchers independently selected and screened the documents,extracted data and evaluated the quality of the documents according to the inclusion and exclusion criteria.The data of the final entries were systematically evaluated and analyzed by using the Stata.12 software.Results: Ten eligible studies(9 RCTs and 1 cohort)were screened for 1945 elderly patients with NS-NSCLC.The results showed that:(1)Overall,the Hazard ratios(HR)of Progression-free survival(PFS)and overall survival(OS)of elderly NS-NSCLC patients treated with bevacizumab combined with platinum-containing chemotherapy and chemotherapy alone were 0.89(95% CI: 0.64-1.25,P = 0.511)and 0.93(95% CI: 0.78-1.12,P = 0.462),respectively,with no statistically significant differences.The PFS with bevacizumab combined with paclitaxel + carboplatin significantly(HR = 0.70,95% CI: 0.55-0.90;P = 0.004)had a significant survival benefit more than paclitaxel + carboplatin.(2)The mPFS and mOS of elderly patients with NS-NSCLC using bevacizumab combined with platinum-containing chemotherapy were 6.04 months(95% CI: 5.37-6.70)and 12.89 months(95% CI: 11.45-14.32).The objective response rate(ORR)was 33%(95% CI: 27%-38%),and the grade 3 and above adverse events(AE)were 79%(95% CI: 71%-85%).The common adverse reactions included 38% neutropenia,23% thrombocytopenia,6% hypertension and 3% proteinuria.Conclusions: In terms of efficacy,bevacizumab has not shown any significant benefit on PFS and OS in elderly patients with NS-NSCLC compared with chemotherapy alone.In combination with paclitaxel plus carboplatin,bevacizumab can significantly prolong the elderly patients PFS.The toxicity of bevacizumab combined with chemotherapy in elderly patientsis is manageable.