Association of bevacizumab and stroke in ovarian cancer: a systematic review and meta-analysis

Abstract

BackgroundThe prognosis for patients with ovarian cancer is bleak. Clinical trials have shown the efficacy of bevacizumab in ovarian cancer treatment. However, life-threatening strokes may limit the usage of bevacizumab and require specific follow-up strategies. This study aims to systematically evaluate the risk of stroke of bevacizumab treatment in ovarian cancer.MethodsWe retrieved all relevant articles published up to December 4th, 2022, from Embase, PubMed, Web of Science, and the Cochrane Library. The risk of stroke in patients with ovarian cancer treated with bevacizumab combined with chemotherapy was analyzed. Meta-analysis was performed using the Stata 17 software and R 4.2.1 program.ResultsSix randomized controlled trials (RCTs) of bevacizumab combined with chemotherapy or chemotherapy for ovarian cancer and six single-experimental-arm trials were included in this study. The meta-analysis showed a pooled risk ratio (RR) of 2.14 [95% confidence interval (CI): 0.88–7.99] for patients with ovarian cancer treated with bevacizumab combined with chemotherapy. Subgroup analyses showed that the incidence of stroke-related adverse events in the carboplatin + paclitaxel + bevacizumab group was 0.01% (95% CI: 0.00–0.01, p < 0.01). The incidence of stroke-related adverse events was 0.01% (95% CI: 0.00–0.01, p < 0.01) in patients aged ≥60. The incidence of stroke caused by cerebral ischemia and cerebral hemorrhage was 0.01% (95% CI: 0.01–0.02, p = 0.27) and 0.01% (95% CI: 0.00–0.01, p < 0.01), respectively.ConclusionsThis meta-analysis indicates that chemotherapy combined with bevacizumab may not increase the incidence of stroke in patients with ovarian cancer. However, stroke-related adverse events may be higher in older patients. Cerebral hemorrhage might cause the incidence of stroke more than cerebral ischemia.Systematic review registrationPROSPERO (CRD42022381003).

Bevacizumab Combination Therapy Versus Standard Chemotherapy for Ovarian Cancer in Shorter and Longer Follow-Up Duration

“…28 Another meta-analysis revealed an important association between the incidence of stroke-related adverse events in the bevacizumab group, consisting of older patients; however, the addition of bevacizumab to the standard chemotherapy regimen for ovarian cancer does not result in an increased incidence of stroke. 29 Other less frequently reported grade 1 to 2 and grade 3 adverse events included gastrointestinal, cardiac, and dermatologic complications. The incidence of grade 1 to 2 and grade 3 hypertension was reported to be higher in the intervention group as compared with the control group; hence, clinicians should consider this potential complication in hypertensive patients.…”