Efficacy And Safety Of Intraperitoneal Bevacizumab Combined With Chemotherapeutic Agents In The Treatment Of Malignant Ascites:A Meta-analysis

Objectives: To investigate the efficacy and safety of intraperitoneal bevacizumab combined with chemotherapeutic agents(compared with intraperitoneal chemotherapeutic agents alone)in the treatment of malignant ascites.To evaluate the effect of intraperitoneal chemotherapeutic agents combined with bevacizumab on vascular endothelial growth factor(VEGF)in malignant ascites and the quality of life.To obtain evidence-based support for the use of intraperitoneal bevacizumab in the treatment of malignant ascites.Materials and Methods: Databases including the Embase,Cochrance Library,PubMed,China National Knowledge Infrastructure(CNKI)and so on were searched to identify studies of intraperitoneal bevacizumab combined with chemotherapeutic agents for the treatment of malignant ascites.Reviewer Manager v.5.3 and Stata v.14.0 software were used to perform this meta-analysis.The main endpoint was objective response rate(ORR),and the secondary endpoints were disease control rate(DCR),main incidence of adverse effects,quality of life improvement rate,and decreased VEGF levels in malignant ascites.Results: The final analysis included 8 trials with a total of 516 patients.Compared with only intraperitoneal chemotherapeutic agents,the bevacizumab combination treatment significantly improved the ORR [risk ratio(RR)= 1.45,95% confidence interval(CI)1.29–1.63,P<0.00001] and DCR(RR=1.12,95% CI 1.04–1.22,P=0.004)in treating malignant ascites.There was no increase in adverse effects in response to intraperitoneal chemotherapeutic agents and bevacizumab treatment(p<0.05).Intraperitoneal bevacizumab reduced the VEGF level in ascites [standardized mean difference(SMD)=–6.77,95% CI –8.45 to –5.09,p<0.00001] and significantly improved the quality of life(RR=1.65,95% CI 1.39–1.96,p<0.00001).Conclusions: Compared with only intraperitoneal chemotherapeutic agents,the participation of bevacizumab could has a better efficacy and did not increase adverse effects.Both from the clinical perspective and molecular level,the treatment of malignant ascites are of great significance.