The impact of Bevacizumab (Avastin) on survival in metastatic solid tumors--a meta-analysis and systematic review
To evaluate the effect of Bevacizumab in combination with chemotherapy on overall survival of patients with metastatic solid tumors. A systematic literature search to identify randomized trials comparing chemotherapy with and without Bevacizumab in metastatic cancer. The primary end point was overal...
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| Veröffentlicht in: | PloS one 2013-01, Vol.8 (1), p.e51780 |
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| creator | Amit, Limor Ben-Aharon, Irit Vidal, Liat Leibovici, Leonard Stemmer, Salomon |
| description | To evaluate the effect of Bevacizumab in combination with chemotherapy on overall survival of patients with metastatic solid tumors.
A systematic literature search to identify randomized trials comparing chemotherapy with and without Bevacizumab in metastatic cancer. The primary end point was overall survival (OS) and the secondary end points were progression free survival (PFS) and toxicity. A meta-analysis was performed for each tumor type and for the combination of all tumors.
24 randomized trials with 8 different types of malignancies were included in this meta-analysis. Patients treated with Bevacizumab had an OS benefit, hazard ratio (HR) 0.89 (95% CI 0.84-0.93, P |
| doi_str_mv | 10.1371/journal.pone.0051780 |
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A systematic literature search to identify randomized trials comparing chemotherapy with and without Bevacizumab in metastatic cancer. The primary end point was overall survival (OS) and the secondary end points were progression free survival (PFS) and toxicity. A meta-analysis was performed for each tumor type and for the combination of all tumors.
24 randomized trials with 8 different types of malignancies were included in this meta-analysis. Patients treated with Bevacizumab had an OS benefit, hazard ratio (HR) 0.89 (95% CI 0.84-0.93, P<0.00001 I(2)-4%). The combined analysis showed a PFS benefit with a HR 0.71 (95% CI 0.68-0.74, P<0.00001, I(2)-54%). The toxicity analysis showed a statistically significant increase in fatal adverse events (FAEs) in the Bevacizumab treatment arm, risk ratio (RR) 1.47 (95% CI 1.1-1.98). A separate analysis of the lung cancer trials showed an increased risk of fatal pulmonary hemorrhage with a RR of 5.65 (95% CI 1.26-25.26). The risk of G3-4 adverse events was increased: RR 1.2 (95% CI 1.15-1.24).
in this combined analysis Bevacizumab improved OS (with little heterogeneity) and PFS. These results should be considered in the light of lack of markers predictive of response and the increased severe and fatal toxicity seen with Bevacizumab treatment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0051780</identifier><identifier>PMID: 23349675</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Angiogenesis inhibitors ; Angiogenesis Inhibitors - adverse effects ; Angiogenesis Inhibitors - pharmacology ; Angiogenesis Inhibitors - therapeutic use ; Antibodies, Monoclonal, Humanized - adverse effects ; Antibodies, Monoclonal, Humanized - pharmacology ; Antibodies, Monoclonal, Humanized - therapeutic use ; Bevacizumab ; Breast cancer ; Cancer ; Cancer metastasis ; Care and treatment ; Chemotherapy ; Clinical trials ; Colorectal cancer ; Health risks ; Hemorrhage ; Humans ; Immunotherapy ; Lung cancer ; Lung diseases ; Medicine ; Meta-analysis ; Metastases ; Monoclonal antibodies ; Neoplasm Metastasis ; Neoplasms - drug therapy ; Neoplasms - pathology ; Patients ; Randomization ; Risk ; Solid tumors ; Statistical analysis ; Studies ; Survival ; Survival Analysis ; Systematic review ; Targeted cancer therapy ; Toxicity ; Tumors ; Vascular endothelial growth factor</subject><ispartof>PloS one, 2013-01, Vol.8 (1), p.e51780</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Amit et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Amit et al 2013 Amit et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-5a8ca9081bc4d741f8e6e213480e7ef6fd7735e46f633b26a5929a4d81590ed43</citedby><cites>FETCH-LOGICAL-c593t-5a8ca9081bc4d741f8e6e213480e7ef6fd7735e46f633b26a5929a4d81590ed43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551962/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551962/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23349675$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Perez-Gracia, Jose Luis</contributor><creatorcontrib>Amit, Limor</creatorcontrib><creatorcontrib>Ben-Aharon, Irit</creatorcontrib><creatorcontrib>Vidal, Liat</creatorcontrib><creatorcontrib>Leibovici, Leonard</creatorcontrib><creatorcontrib>Stemmer, Salomon</creatorcontrib><title>The impact of Bevacizumab (Avastin) on survival in metastatic solid tumors--a meta-analysis and systematic review</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To evaluate the effect of Bevacizumab in combination with chemotherapy on overall survival of patients with metastatic solid tumors.
A systematic literature search to identify randomized trials comparing chemotherapy with and without Bevacizumab in metastatic cancer. The primary end point was overall survival (OS) and the secondary end points were progression free survival (PFS) and toxicity. A meta-analysis was performed for each tumor type and for the combination of all tumors.
24 randomized trials with 8 different types of malignancies were included in this meta-analysis. Patients treated with Bevacizumab had an OS benefit, hazard ratio (HR) 0.89 (95% CI 0.84-0.93, P<0.00001 I(2)-4%). The combined analysis showed a PFS benefit with a HR 0.71 (95% CI 0.68-0.74, P<0.00001, I(2)-54%). The toxicity analysis showed a statistically significant increase in fatal adverse events (FAEs) in the Bevacizumab treatment arm, risk ratio (RR) 1.47 (95% CI 1.1-1.98). A separate analysis of the lung cancer trials showed an increased risk of fatal pulmonary hemorrhage with a RR of 5.65 (95% CI 1.26-25.26). The risk of G3-4 adverse events was increased: RR 1.2 (95% CI 1.15-1.24).
in this combined analysis Bevacizumab improved OS (with little heterogeneity) and PFS. These results should be considered in the light of lack of markers predictive of response and the increased severe and fatal toxicity seen with Bevacizumab treatment.</description><subject>Analysis</subject><subject>Angiogenesis inhibitors</subject><subject>Angiogenesis Inhibitors - adverse effects</subject><subject>Angiogenesis Inhibitors - pharmacology</subject><subject>Angiogenesis Inhibitors - therapeutic use</subject><subject>Antibodies, Monoclonal, Humanized - adverse effects</subject><subject>Antibodies, Monoclonal, Humanized - pharmacology</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Bevacizumab</subject><subject>Breast cancer</subject><subject>Cancer</subject><subject>Cancer metastasis</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Colorectal cancer</subject><subject>Health risks</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Lung cancer</subject><subject>Lung diseases</subject><subject>Medicine</subject><subject>Meta-analysis</subject><subject>Metastases</subject><subject>Monoclonal antibodies</subject><subject>Neoplasm Metastasis</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - pathology</subject><subject>Patients</subject><subject>Randomization</subject><subject>Risk</subject><subject>Solid tumors</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Systematic review</subject><subject>Targeted cancer therapy</subject><subject>Toxicity</subject><subject>Tumors</subject><subject>Vascular endothelial growth factor</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNp1Uk1v1DAUjBCIlsI_QGCJCxyy2PH3pdJS8VGpEpdytl4cZ-tVEm_tZNHy6_HuplVXAvlg672ZefOsKYq3BC8IleTzOkxxgG6xCYNbYMyJVPhZcU40rUpRYfr8yfuseJXSOoOoEuJlcVZRyrSQ_Ly4v71zyPcbsCMKLfritmD9n6mHGn1cbiGNfviEwoDSFLd-Cx3yA-rdmBsweotS6HyDxqkPMZUlHFolZFu75BOCoUFpl0bXH8DRbb37_bp40UKX3Jv5vih-fft6e_WjvPn5_fpqeVNarulYclAWNFaktqyRjLTKCVcRyhR20rWibaSk3DHRCkrrSgDXlQbWKMI1dg2jF8X7o-6mC8nMv5UMoZWUUimMM-L6iGgCrM0m-h7izgTw5lAIcWUgZuOdMyBJ7QSrpaooc9pq0VbAOQWiZZMHZq3LedpU966xbhgjdCeip53B35lV2BrKOdGiygIfZoEY7ieXxv9YnlEryK780IYsZnufrFkyqYiQWO5XX_wDlU_jem9zXlqf6ycEdiTYGFKKrn00TrDZp-3BjNmnzcxpy7R3T5d-JD3Ei_4FQuLSaw</recordid><startdate>20130122</startdate><enddate>20130122</enddate><creator>Amit, Limor</creator><creator>Ben-Aharon, Irit</creator><creator>Vidal, Liat</creator><creator>Leibovici, Leonard</creator><creator>Stemmer, Salomon</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20130122</creationdate><title>The impact of Bevacizumab (Avastin) on survival in metastatic solid tumors--a meta-analysis and systematic review</title><author>Amit, Limor ; Ben-Aharon, Irit ; Vidal, Liat ; Leibovici, Leonard ; Stemmer, Salomon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c593t-5a8ca9081bc4d741f8e6e213480e7ef6fd7735e46f633b26a5929a4d81590ed43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Analysis</topic><topic>Angiogenesis inhibitors</topic><topic>Angiogenesis Inhibitors - adverse effects</topic><topic>Angiogenesis Inhibitors - pharmacology</topic><topic>Angiogenesis Inhibitors - therapeutic use</topic><topic>Antibodies, Monoclonal, Humanized - adverse effects</topic><topic>Antibodies, Monoclonal, Humanized - pharmacology</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Bevacizumab</topic><topic>Breast cancer</topic><topic>Cancer</topic><topic>Cancer metastasis</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Clinical trials</topic><topic>Colorectal cancer</topic><topic>Health risks</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Lung cancer</topic><topic>Lung diseases</topic><topic>Medicine</topic><topic>Meta-analysis</topic><topic>Metastases</topic><topic>Monoclonal antibodies</topic><topic>Neoplasm Metastasis</topic><topic>Neoplasms - drug therapy</topic><topic>Neoplasms - pathology</topic><topic>Patients</topic><topic>Randomization</topic><topic>Risk</topic><topic>Solid tumors</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Systematic review</topic><topic>Targeted cancer therapy</topic><topic>Toxicity</topic><topic>Tumors</topic><topic>Vascular endothelial growth factor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amit, Limor</creatorcontrib><creatorcontrib>Ben-Aharon, Irit</creatorcontrib><creatorcontrib>Vidal, Liat</creatorcontrib><creatorcontrib>Leibovici, Leonard</creatorcontrib><creatorcontrib>Stemmer, Salomon</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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A systematic literature search to identify randomized trials comparing chemotherapy with and without Bevacizumab in metastatic cancer. The primary end point was overall survival (OS) and the secondary end points were progression free survival (PFS) and toxicity. A meta-analysis was performed for each tumor type and for the combination of all tumors.
24 randomized trials with 8 different types of malignancies were included in this meta-analysis. Patients treated with Bevacizumab had an OS benefit, hazard ratio (HR) 0.89 (95% CI 0.84-0.93, P<0.00001 I(2)-4%). The combined analysis showed a PFS benefit with a HR 0.71 (95% CI 0.68-0.74, P<0.00001, I(2)-54%). The toxicity analysis showed a statistically significant increase in fatal adverse events (FAEs) in the Bevacizumab treatment arm, risk ratio (RR) 1.47 (95% CI 1.1-1.98). A separate analysis of the lung cancer trials showed an increased risk of fatal pulmonary hemorrhage with a RR of 5.65 (95% CI 1.26-25.26). The risk of G3-4 adverse events was increased: RR 1.2 (95% CI 1.15-1.24).
in this combined analysis Bevacizumab improved OS (with little heterogeneity) and PFS. These results should be considered in the light of lack of markers predictive of response and the increased severe and fatal toxicity seen with Bevacizumab treatment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23349675</pmid><doi>10.1371/journal.pone.0051780</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analysis Angiogenesis inhibitors Angiogenesis Inhibitors - adverse effects Angiogenesis Inhibitors - pharmacology Angiogenesis Inhibitors - therapeutic use Antibodies, Monoclonal, Humanized - adverse effects Antibodies, Monoclonal, Humanized - pharmacology Antibodies, Monoclonal, Humanized - therapeutic use Bevacizumab Breast cancer Cancer Cancer metastasis Care and treatment Chemotherapy Clinical trials Colorectal cancer Health risks Hemorrhage Humans Immunotherapy Lung cancer Lung diseases Medicine Meta-analysis Metastases Monoclonal antibodies Neoplasm Metastasis Neoplasms - drug therapy Neoplasms - pathology Patients Randomization Risk Solid tumors Statistical analysis Studies Survival Survival Analysis Systematic review Targeted cancer therapy Toxicity Tumors Vascular endothelial growth factor |
| title | The impact of Bevacizumab (Avastin) on survival in metastatic solid tumors--a meta-analysis and systematic review |
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