The Adverse Events Of Bevacizumab In Combination With Chemotherapy For Recurrent Ovarian Cancer:a Meta Analysis

Research background and purpose:Ovarian cancer is one of the most common malignant tumors in the female reproductive system.Its incidence accounts for the third place in gynecological malignancies,but the recurrence rate and mortality rate rank first.The treatment of recurrent ovarian cancer has always been a very difficult problem.Conventional treatment methods include chemotherapy,secondary tumor cytoreductive surgery,molecular targeted therapy,radiotherapy,and immunotherapy and so on.At present,chemotherapy is still the leading treatment,but the clinical remission rate is also very low.It is the current main task to develop a safe and effective second-line chemotherapy regimen and a combination of multiple treatments through reasonable and objective assessment of patients,but the combined use of multiple chemotherapy drugs will also increase the incidence of adverse effects.Some adverse effects are lethal.This study collected bevacizumab(BEV)combined with chemotherapy for recurrent ovarian cancer(ROC)randomized controlled trial(RCT)or retrospective cohort study(RCS)Meta-analysis was performed to analyze the risk of adverse effects of bevacizumab combined with chemotherapy on ROC,providing evidence-based medical evidence and scientific reference for its safer use in clinical treatment of ROC.Research methods:The Chinese and English databases are searched by the computer,including Chinese database,Wanfang data knowledge service platform,Chinese biomedical literature(CBM)database,VIP database and other Chinese databases,as well as English databases such as Medline,Pubmed,Cochrane Library and Embase.The search time is set to build the library until December 2018.According to the inclusion criteria and exclusion criteria,18 articles were included in the literature,and 2,523 ROC patients,including 1278 patients in the BEV combined chemotherapy group and 1245 patients in the conventional chemotherapy group.The raw data in the literature were extracted and analyzed and by the RevMan5.3 statistical software provided by Cochrane.The forest map,odds ratio(OR)and its 95% confidence interval(CI)were drawn.Research results:1.For recurrent ovarian cancer,compared with conventional chemotherapy group BEV combined with chemotherapy group can increase the occurrence ri sk of wound healing complications [P=0.02<0.05,OR=5.01,95% CI(1.28-19.60)],gastrointestinal perforation [P=0.02<0.05,OR=7.11,95% CI(1.28-39.52)],thrombus [P=0.003<0.05,OR=2.03,95% CI(1.27-3.26)],hemorrhage [P<0.00001,OR=4.87,95% CI(3.42-6.93)],proteinuria [P<0.00001,OR=11.33,95% CI(5.71-22.48)],hypertension [P=0.001<0.05,OR=4.84,95% CI(1.88-12.41)] The risk of occurrence;for platinum-resistant ROC,BEV combined with chemother apy did not increase the occurrence risk of proteinuria [P=0.07>0.05,OR=4.26,95%CI(0.90-20.25)],hemorrhage [P=0.14>0.05,OR=2.54,95%CI(0.73-8.88)],thro mbus [P=0.37>0.05,OR=1.49,95%CI(0.63-3.55)].2.For recurrent ovarian cancer,compared with conventional chemotherapy group,BEV combined with chemotherapy group did not increase the occurren ce risk of reversible posterior leukoencephalopathy syndrome [P=0.15>0.05,OR=4.89,95% CI(0.57-42.20)],hand-foot syndrome [P=0.15 >0.05,OR=1.45,95% CI(0.88-2.38)],fistula or abscess [[P=0.09>0.05,OR=2.75,95% CI(0.86-8.73)],anemia [P=0.41,OR= 0.71>0.05,95% CI(0.32-1.59)],heart failure [P=0.54>0.05,OR=1.53,95% CI(0.40-5.86)],thrombocytopenia [P=0.64>0.05,OR=1.19,95% CI(0.57-2.49)],neutropenia [P=0.20>0.05,OR=1.18,95% CI(0.92-1.53)],l eukopenia [P=0.38>0.05,OR=0.84,95 %CI(0.58-1.23)],gastrointestinal reaction [P=0.31>0.05,HR=0.85,95% CI(0.62-1.17)].Research conclusion:1.For recurrent ovarian cancer,BEV combined with chemotherapy increases the risk of wound healing complications,gastrointestinal perforation,thrombosis,hemorrhage,hypertension,and proteinuria.For the platinum-resistant recurrent ovarian cancer subgroup,BEV combined with chemotherapy does not increase the risk of proteinuria,hemorrhage,and thrombosis.2.For recurrent ovarian cancer,BEV combined with chemotherapy does not increase the risk of reversible posterior leukoencephalopathy syndrome,hand-foot syndrome,fistula or abscess,anemia,heart failure,thrombocytopenia,leukopenia,neutropenia,and gastrointestinal reactions;...