Unravelling the Potential Use of Bevacizumab for Recurrent Glioblastoma: A Systematic Review and Meta-Analysis

Introduction: Unlike many other anti-VEGF medications that have been studied in significant RCTs, such as nivolumab (anti-VEGF neutralizing antibody), cediranib (VEGF inhibitor), aflibercept (soluble VEGFR), and regorafenib (VEGF-TKI), bevacizumab has produced mixed outcomes in terms of PFS and OS. We aimed to assess the safety and efficacy of bevacizumab for patients with recurrent GBM.

Methods: Until 31 December 2022, the authors combed the PubMed, MEDLINE, and Clinicaltrials.gov databases for available English-language literature. Recurrent glioblastoma, rGBM, Astrocytoma grade IV, Recurrent Grade IV Astrocytoma, Recurrent High-grade IV Gliomas, Bevacizumab, and Avastin, were utilized in our search. The search and identification of pertinent data were conducted separately by two investigators. The primary key interest of current of our study was progression-free survival (PFS), whereas the secondary outcomes were overall survival (OS) and objective response rate (ORR).

Results: This meta-analysis showed that the administration of bevacizumab seems to slightly improve OS (HR 1.08 [0.94, 1.24]; p = 0.26; I2 = 0%), PFS (1.12 [0.79, 1.58]; p = 0.53; I2 = 82%), and ORR (HR 1.48 [0.74, 2.95]; p = 0.27; I2 = 87%) as HR less than one indicates a positive effect, but no significant differences.

Conclusion : There were no significant changes, the administration of bevacizumab appeared to enhance OS, PFS, and ORR marginally.