Efficacy and safety of bevacizumab combined with first-generation egfr-tki in the first-line treatment of egfr-mutated advanced non-small cell lung cancer: A meta-analysis / 肿瘤

ABSTRACT

Objective: To evaluate the efficacy and safety of Bevacizumab (BEV) combined with first-generation EGFR-TKI versus first-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) alone in the first-line treatment of EGFR-mutated positive (EGFRm) advanced non-small cell lung cancer(NSCLC). Methods: PubMed, Cochrane Library, Embase, Weipu chinese journal, China Biology Medicine database, China National Knowledge Infrastructure and Wanfang relevant databases were searched to collect randomized controlled trials (RCTs) of BEV combined with first-generation EGFR-TKI (experimental group) versus first-generation EGFR-TKI alone (control group) in the first-line treatment of EGFRm advanced NSCLC from database foundation to July, 2019. The data in the included RCTs were extracted, and the qualities were assessed in accordance with Cochrane Collaboration, and a Meta-analysis was conducted with RevMan 5.3 software, Risk ratio (RR), hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results: A total of 7 RCTs were enrolled, including 834 patients. The results of meta-analysis showed that experimental group was better than control group in objective response rate (ORR) (RR = 1.27, 95% CI 1.15-1.41, P < 0.000 01), disease control rate (DCR) (RR = 1.10, 95% CI 1.02-1.20, P = 0.02) and progression-free survival (PFS) (HR = 0.57, 95% CI 0.44-0.75, P < 0.000 1) in terms of efficacy. In terms of safety, the incidences of hypertension (RR = 4.11, 95% CI 2.95-5.93, P < 0.000 01], proteinuria (RR = 5.16, 95% CI 3.40-7.83, P < 0.000 01), hemorrhage (RR = 3.34, 95% CI 2.37-4.72, P<0.000 01) were higher in experimental group. There was no significant difference between the two groups in the incidences of rash (RR = 1.00, 95% CI 0.92-1.08, P = 0.91), diarrhea (RR=1.05, 95% CI 0.91-1.21, P = 0.52), hypohepatia (RR = 0.91, 95% CI 0.72-1.14, P = 0.42). Conclusion: BEV combined with first-generation EGFR-TKI significantly improve ORR, DCR and PFS in the first-line treatment of EGFRm advanced NSCLC, but also increase the risks of hypertension, proteinuria and hemorrhage.