Reduced-dose bevacizumab vs. standard-dose bevacizumab in recurrent high-grade glioma: Which one is better? A meta-analysis
Reduced-dose bevacizumab vs. standard-dose bevacizumab in recurrent high-grade glioma: Which one is better? A meta-analysis
复制标题
减少剂量贝伐单抗与标准剂量贝伐单抗治疗复发性高级别胶质瘤：哪一种更好？
DOI：
10.1016/j.clineuro.2020.106239
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发表时间：
2020-11-01
影响因子：
1.9
通讯作者：
Du, Shasha
中科院分区：
文献类型：
--
作者：
Chen, Yulei;Guo, Longbin;Du, Shasha
背景：基于有效的放射学反应，贝伐单抗已被广泛用于治疗复发的高级别胶质瘤。尽管目前的标准剂量是每周5 mg/kg，但Bev的最佳剂量仍存在争议，因为近年来进行的剂量-反应研究很少。因此，我们进行了一项荟萃分析，以探讨减少剂量的贝伐单抗与标准剂量的贝伐单抗在复发性高级别胶质瘤治疗中的价值。方法：检索三个主要的电子数据库(PubMed、EMBASE和Cochrane Library)，检索2020年2月前发表的符合条件的文献。纳入低剂量贝伐单抗与常规剂量治疗进展性高级别胶质瘤的文献，合格研究的终点应该是无进展生存期(PFS)和总生存期(OS)。结果：共纳入4项队列研究，包括552例患者(减量BEV组257例，标准剂量BEV组295例)。与常规剂量相比，小剂量BEV对脑胶质瘤有一定的保护作用，但OS(HR0.77；95%CI0.53~1.10；P=0.151)和PFS(HR0.66；95%CI0.37~1.20；P=0.175)差异无统计学意义。结论：低剂量贝伐单抗治疗复发性高级别脑胶质瘤，其OS和PFS与标准剂量贝伐单抗相似，且副作用少，治疗费用低。因此，对于复发的高级别胶质瘤患者，小剂量贝伐单抗是一种很有前途的治疗选择。还需要进一步的前瞻性随机试验来证实我们的结果。
Background: Based on the effective radiological responses, bevacizumab (BEV) has been widely used in the treatment of recurrent high-grade glioma. Although the current standard dose is 5 mg/kg/week, the optimal dosage of BEV is controversial, as few dose-response studies have been performed in recent years. Therefore, we conducted a meta-analysis to explore the value of reduced-dose bevacizumab versus standard-dose bevacizumab in recurrent high-grade glioma treatment.Methods: Three major electronic databases (PubMed, EMBASE and the Cochrane Library) were searched for eligible documents published before February 2020. Literature on low-dose bevacizumab versus conventional dose in progressive high-grade glioma was included, and the endpoints of eligible researches should be progression-free survival (PFS) and overall survival (OS). All available data were collected and then analyzed with Stata software.Results: Four cohort studies were evaluated, including 552 patients (reduced-dose BEV group: 257, standard-dose BEV group: 295). Low dose BEV seems to slightly improve survival compared to conventional dose as HR < 1 indicates a protective effect, but no significant differences in OS (HR 0.77; 95 % CI 0.53-1.10; P = 0.151) and PFS (HR 0.66; 95 % CI 0.37-1.20; P = 0.175) were found between the two groups in this study.Conclusion: Reduced-dose bevacizumab schedule resulted in similar OS and PFS to standard-dose bevacizumab in recurrent high-grade glioma, with less side effects and less cost of treatment. Therefore, low-dose bevacizumab represents a promising therapeutic option for recurrent high-grade glioma patients. Further prospective randomized trials are needed to confirm our results.