Summary

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• Avastin (bevacizumab) is indicated for the treatment of metastatic colorectal cancer, in combination with intravenous fluorouracil-based chemotherapy for first- or second-line treatment; for the treatment of metastatic colorectal cancer, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy for second-line treatment in patients who have progressed on a first-line bevacizumab product-containing regimen; for the treatment of unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer, in combination with carboplatin and paclitaxel for first-line treatment; for the treatment of recurrent glioblastoma in adults; for the treatment of metastatic renal cell carcinoma in combination with interferon alfa; for the treatment of persistent, recurrent, or metastatic cervical cancer, in combination with paclitaxel and cisplatin, or paclitaxel and topotecan; for the treatment of epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and paclitaxel, followed by Avastin as a single agent, for stage III or IV disease following initial surgical resection; for the treatment of epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for platinum-resistant recurrent disease who received no more than 2 prior chemotherapy regimens; for the treatment of epithelial ovarian, fallopian tube, or primary peritoneal cancer, in combination with carboplatin and paclitaxel or carboplatin and gemcitabine, followed by Avastin as a single agent, for platinum-sensitive recurrent disease; and for the treatment of hepatocellular carcinoma (HCC), in combination with atezolizumab for the treatment of patients with unresectable or metastatic HCC who have not received prior systemic therapy.
• This summary is based on the review of 165 systematic reviews/meta-analyses. ^[1-165]
• Progression-Free Survival (PFS) and Overall Survival (OS): Bevacizumab (Avastin) combined with FTD/TPI in refractory metastatic colorectal cancer (mCRC) resulted in a median OS ranging from 8.6 to 14.4 months and a median PFS from 3.7 to 6.8 months. In non-small cell lung cancer (NSCLC), when combined with EGFR-TKIs (e.g., erlotinib), it significantly prolonged PFS (HR: 0.58-0.61) but did not significantly improve OS. In advanced hepatocellular carcinoma (HCC), the combination of bevacizumab and atezolizumab was superior to sorafenib in terms of OS.
• Objective Response Rate (ORR): In NSCLC, bevacizumab combined with chemotherapy improved ORR (ranging from 1.11 to 1.25). Across studies in both NSCLC and mCRC, bevacizumab generally demonstrated improved ORR when compared to placebo or standard chemotherapy.
• Disease Control Rate (DCR): Bevacizumab improved DCR when used in combination with chemotherapy or other targeted therapies across various cancer types. This improvement was generally better than other targeted therapies in both mCRC and NSCLC.
• Effectiveness Across Subgroups: The effectiveness of bevacizumab varied by patient subgroups. For instance, patients with specific EGFR mutations showed differential benefits when bevacizumab was combined with EGFR-TKIs. Age and gender were also factors, with older adults and females exhibiting different risk profiles for adverse effects, though differences in effectiveness were not consistently reported.
• Common Adverse Events (AEs) with Bevacizumab (Avastin): Frequently reported AEs include hypertension, proteinuria, neutropenia, and gastrointestinal perforations, with a higher incidence of grade 3-4 AEs observed when bevacizumab is combined with chemotherapy or other targeted therapies.
• Discontinuation Due to Adverse Events: Discontinuation rates for bevacizumab due to AEs varied across studies, ranging from 0% to 17%. This rate was comparable or higher than other targeted therapies, indicating a need for careful monitoring in patients at higher risk for severe AEs.
• Increased Risks of Specific AEs: Bevacizumab treatment is associated with an increased risk of hypertension, proteinuria, and hemorrhagic events, particularly when used in combination with other cancer therapies.
• Subgroup-Specific Safety Concerns: Older adults exhibited a higher risk of severe neutropenia and other AEs, while females were more prone to certain AEs like neutropenia and gastrointestinal issues. Additionally, the safety profile varied among patients with different EGFR mutation statuses, particularly when bevacizumab was used with EGFR-TKIs.
• Age and Gender Differences: Older adults treated with bevacizumab had a higher risk of severe adverse events, such as neutropenia, compared to younger patients. Females were more likely to experience specific adverse events, including neutropenia and gastrointestinal issues, when receiving bevacizumab in combination therapies.
• EGFR Mutation Influence: The effectiveness of bevacizumab, particularly when combined with EGFR-TKIs, was influenced by the presence of specific EGFR mutations (e.g., exon 19 deletion, L858R). Patients with these mutations experienced differential benefits, indicating that mutation status should be considered when selecting treatment regimens.