PubMed, EMBASE, Cochrane and Clinical trials.gov databases were searched for English language studies of randomized controlled trials comparing
bevacizumab and adjuvant
therapy with adjuvant
therapy alone published from January 1966 to 7th of May 2014. Progression free survival, overall survival, overall response rate, safety and quality of life were analyzed using random- or fixed-effects models according to the
PRISMA guidelines. We obtained data from 44 randomized controlled trials (30,828 patients). Combining
bevacizumab with different adjuvant
therapies resulted in significant improvement of progression free survival (log hazard ratio, 0.87; 95% confidence interval (CI), 0.84-0.89), overall survival (log hazard ratio, 0.96; 95% CI, 0.94-0.98) and overall response rate (relative risk, 1.46; 95% CI: 1.33-1.59) compared to adjuvant
therapy alone in all studied
tumor types. In subgroup analyses, there were no interactions of
bevacizumab with baseline characteristics on progression free survival and overall survival, while overall response rate was influenced by
tumor type and
bevacizumab dose (p-value: 0.02). Although
bevacizumab use resulted in additional expected
adverse drug reactions except
anemia and
fatigue, it was not associated with a significant decline in quality of life. There was a trend towards a higher risk of several side effects in patients treated by high-dose
bevacizumab compared to the low-dose e.g. all grade
proteinuria (9.24; 95% CI: 6.60-12.94 vs. 2.64; 95% CI: 1.29-5.40).
CONCLUSIONS: