Risk of Adverse Vascular Events in Patients with Malignant Glioma Treated with Bevacizumab Plus Irinotecan: A Systematic Review and Meta-Analysis
Risk of Adverse Vascular Events in Patients with Malignant Glioma Treated with Bevacizumab Plus Irinotecan: A Systematic Review and Meta-Analysis
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接受贝伐单抗联合伊立替康治疗的恶性胶质瘤患者发生不良血管事件的风险：系统评价和荟萃分析
DOI：
10.1016/j.wneu.2019.06.043
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Jinquan Cai
中科院分区：
文献类型：
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作者：
Jiawei Dong;Xiangqi Meng;Siyi Li;Qun Chen;Lei Shi;Chuanlu Jiang;Jinquan Cai
背景：贝伐单抗联合伊立替康是治疗恶性胶质瘤患者的一种新的有益的化疗策略。这项系统性综述和荟萃分析的目的是全面评估贝伐单抗联合伊立替康治疗成人恶性胶质瘤患者发生不良血管事件的风险。方法检索Cochrane图书馆、Embase和PubMed，检索截至2018年6月的相关试验。两名调查人员筛选了所有标题和摘要，以确定是否可能包括在内，并独立提取了数据。纳入6项研究，其中5项为对照组，单独使用贝伐单抗或贝伐单抗与替莫唑胺联用。使用了三个系统来评估证据的质量和建议的程度。使用牛津循证医学证据水平(2009)系统将证据分为5个等级(I-V类)。采用纽卡斯尔-渥太华量表中的STAR系统来评估方法学质量。结果数据显示贝伐单抗联合伊立替康治疗对全身不良事件的风险没有显著影响(优势比[OR]，1.17；95%可信区间[CI]，0.43-3.18)。与未使用伊立替康的对照组相比，贝伐单抗联合伊立替康治疗的患者发生血液毒性(OR，1.06；95%CI，0.26-4.38)、血小板减少(OR，1.07；95%CI，0.25-4.63)和高血压(OR，1.34；95%CI，0.28-6.36)的风险相似。贝伐单抗联合伊立替康治疗组血栓形成发生率明显高于对照组(OR，3.23；95%CI，1.47~7.12)。结论贝伐单抗联合伊立替康治疗恶性胶质瘤患者发生全身不良事件的风险与对照组无显著差异。两组患者出现血液毒性、血小板减少和高血压的风险相似。贝伐单抗联合伊立替康治疗的患者血栓形成的风险更高。对接受贝伐单抗和伊立替康治疗的恶性胶质瘤患者，监测血栓形成和实施抗凝治疗是必要的优点提升。
BackgroundBevacizumab plus irinotecan is a new beneficial chemotherapy strategy for patients with malignant glioma. The purpose of this systematic review and meta-analysis was to comprehensively assess the risk of adverse vascular events in adults with malignant glioma treated with bevacizumab plus irinotecan.MethodsThe Cochrane Library, Embase and PubMed were searched, and relevant trials were identified up to June 2018. Two investigators screened all titles and abstracts for possible inclusion and extracted data independently. Six studies were included, and 5 of them in the control group using bevacizumab alone or bevacizumab with temozolomide. Three systems were used to assess the quality of evidence and the level of recommendation. The Oxford Centre for Evidence-Based Medicine Levels of Evidence (2009) system was used to classify the evidence into 5 levels (classes I–V). The star system from the Newcastle–Ottawa Scale was used to assess methodological quality. The GRADE profiler was used to evaluate the overall body of evidence.ResultsOur data show that bevacizumab plus irinotecan therapy does not significantly affect the risk of systemic adverse events (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.43–3.18). Patients treated with bevacizumab plus irinotecan had a similar risk of hematotoxicity (OR, 1.06; 95% CI, 0.26–4.38), thrombocytopenia (OR, 1.07; 95% CI, 0.25–4.63), and hypertension (OR, 1.34; 95% CI, 0.28–6.36) compared with the control group (those treated without irinotecan). Thrombosis occurred more frequently in patients treated with bevacizumab plus irinotecan compared with the control group (OR, 3.23; 95% CI, 1.47–7.12).ConclusionsThe risk of systemic adverse events was not significantly different between patients with malignant glioma treated with bevacizumab plus irinotecan and the control group. The risks of hematotoxicity, thrombocytopenia, and hypertension were similar in the 2 groups. The risk of thrombosis was higher in patients treated with bevacizumab plus irinotecan. Monitoring for thrombosis and administering anticoagulant therapy as necessary merit promotion for patients with malignant glioma receiving treatment with bevacizumab plus irinotecan.