Abstract:

Objective  To evaluate systematically the efficacy and safety of different bevacizumab-based maintenance strategies in patients with advanced colorectal cancer. Methods The databases PubMed，EMbase，Web of Science，and Cochrane Library were searched for randomized controlled trials published before July 31，2017 involving bevacizumab-based maintenance treatment of advanced colorectal cancer. Data from included studies were extracted，studies were evaluated for quality using the Jadad score，and data were analyzed statistically using RevMan 5.3. Results In the end，eight trials involving 2，644 patients were included in the analysis. Relative to no treatment （NT），bevacizumab-based maintenance therapy （MT；bevacizumab without or with chemotherapy） was associated with significant improvement in progression-free survival（HR＝0.65，95%CI：0.53-0.78，P<0.001） and overall survival（HR＝0.83，95%CI：0.71-0.98，P=0.020）. At the same time，MT was associated with more frequent grade 3/4 sensory neuropathy（P=0.001） and hypertension （P=0.008）. MT and continuous therapy（CT） were associated with similar PFS （HR＝1.05，95%CI：0.56-1.71，P=0.830） and OS （HR＝1.11，95%CI：0.92-1.35，P=0.270）. CT was associated with higher frequency of grade 3/4 sensory neuropathy （P<0.001），fatigue （P=0.020） and hand-foot skin syndrome （P=0.040）. Compared with the group receiving bevacizumab alone，the group receiving bevacizumab plus erlotinib showed better PFS （HR＝0.81，95%CI：0.67-0.96，P=0.020） and OS （HR＝0.81，95%CI：0.67-0.99，P=0.040），albeit with higher incidence of grade 3-4 skin rash（P<0.001）. Conclusions Bevacizumab alone or combined with chemotherapy or erlotinib can significantly improve PFS and OS in patients with advanced colorectal cancer，and most patients tolerate the regimen. Bevacizumab-based maintenance therapy can be recommended as an optimal regimen during the maintenance stage.

Key words: Advanced colorectal cancer, Bevacizumab, Maintenance therapy, Efficacy, Safety, Meta-analysis