Comparative efficacy and safety of low-dose versus high-dose bevacizumab in ovarian cancer: An indirect treatment comparison

IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Josée-Lyne Ethier , Cal Shephard , Diana P. Granados , Nikkita Dutta , Rana Qadeer , Saima Ahmad , Ellen Kasireddy , Mir-Masoud Pourrahmat , Mir Sohail Fazeli
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引用次数: 0

Abstract

Objective

First-line therapy for ovarian cancer involves cytoreductive surgery and platinum-based chemotherapy, with or without bevacizumab. Bevacizumab can be administered at low (7.5 mg/kg every three weeks [Q3W]) or high dose (15 mg/kg Q3W). This study compared the efficacy and safety of these dosing strategies.

Methods

Systematic literature review of Embase, MEDLINE®, and CENTRAL (18/09/2023) identified randomized controlled trials (RCTs) evaluating bevacizumab versus any therapy or control in ovarian, fallopian tube, or primary peritoneal cancer. Indirect treatment comparisons (ITC) of response, survival, and safety outcomes were performed, including sensitivity/subgroup analyses adjusting for heterogeneity.

Results

Six RCTs (sample size: 24–1528 patients) were included for ITC. Five evaluated high-dose bevacizumab with chemotherapy. The common comparator was carboplatin + paclitaxel. Trials mainly included stage III (n = 4) or stage II-III (n = 1) ovarian cancer patients; one did not report cancer stage. Primary analyses showed no significant differences between low- versus high-dose bevacizumab for partial response (risk ratio [95 % confidence interval]: 0.66 [0.42, 1.02]), complete response (1.76 [0.76, 4.11]), objective response rate (1.01 [0.63, 1.61]), progressive disease (1.08 [0.38, 3.10]), clinical benefit (0.89 [0.76, 1.03]), any grade ≥ 3 adverse event (1.53 [0.96, 2.44]), specific grade ≥ 3 adverse events, overall survival (hazard ratio: 0.93 [0.77, 1.13]), or progression-free survival (1.02 [0.86, 1.22]). Sensitivity and subgroup analyses confirmed findings.

Conclusions

This ITC found no significant difference in clinical outcomes between low- and high-dose bevacizumab combination therapy. Despite limitations of small sample size and heterogeneities, findings suggest that bevacizumab dose may not significantly impact ovarian cancer outcomes.

Abstract Image

低剂量与高剂量贝伐单抗治疗卵巢癌的疗效和安全性比较:一项间接治疗比较
目的卵巢癌的一线治疗包括细胞减少手术和铂基化疗,有或没有贝伐单抗。贝伐单抗可低剂量(每3周7.5 mg/kg [Q3W])或高剂量(15 mg/kg Q3W)给药。本研究比较了这些给药策略的有效性和安全性。方法:对Embase、MEDLINE®和CENTRAL(2023年9月18日)的系统文献回顾,确定了随机对照试验(rct),评估贝伐单抗与卵巢癌、输卵管癌或原发性腹膜癌的任何治疗或对照。对疗效、生存和安全性结果进行了间接治疗比较(ITC),包括敏感性/亚组分析,以调整异质性。结果ITC纳入6项随机对照试验(样本量:24-1528例)。5例评估了高剂量贝伐单抗与化疗。常用比较物为卡铂+紫杉醇。试验主要包括III期(n = 4)或II-III期(n = 1)卵巢癌患者;其中一项没有报告癌症分期。初步分析显示,低剂量贝伐单抗与高剂量贝伐单抗在部分缓解(风险比[95%可信区间]:0.66[0.42,1.02])、完全缓解(1.76[0.76,4.11])、客观缓解率(1.01[0.63,1.61])、疾病进展(1.08[0.38,3.10])、临床获益(0.89[0.76,1.03])、任何≥3级不良事件(1.53[0.96,2.44])、特定≥3级不良事件、总生存率(风险比:0.93[0.77, 1.13])或无进展生存期(1.02[0.86,1.22])。敏感性和亚组分析证实了结果。结论:本研究发现低剂量和高剂量贝伐单抗联合治疗的临床结果无显著差异。尽管小样本量和异质性的局限性,研究结果表明,贝伐单抗剂量可能不会显著影响卵巢癌的结局。
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来源期刊
Gynecologic oncology
Gynecologic oncology 医学-妇产科学
CiteScore
8.60
自引率
6.40%
发文量
1062
审稿时长
37 days
期刊介绍: Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy
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