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Anti-vascular endothelial growth factor in glioblastoma: a systematic review and meta-analysis

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Abstract

Glioblastoma is one of the most common primary brain tumors in adults. The current treatment strategies failed to achieve satisfactory outcomes. Anti-vascular endothelial growth factor (anti-VEGF) agents have been proposed to enhance the survival and quality of life in these patients. To investigate this, different databases were searched in addition to hand searching. Relevant studies were screened and only ten randomized controlled trials (RCTs) met the eligibility criteria; six of them were considered for meta-analysis. Eligible RCTs were assessed regarding risk of bias using the Cochrane tool. Relevant data were extracted and meta-analysis was conducted using the random effects model analysis on RevMan software. One thousand seventy-eight patients in the anti-VEGF group and 946 patients in the control group were available for analysis. No statistically significant improvement in the overall survival (OS) was detected for anti-VEGF (OR 0.87, 95% CI 0.7–1.09, p = 0.23) or bevacizumab subgroup (OR 0.84, 95% CI 0.65–1.08, p = 0.17) compared to standard therapy alone. However, the progression-free survival (PFS) showed a significant improvement with both anti-VEGF (OR 0.76, 95% CI 0.65–0.89, p = 0.0007) and bevacizumab subgroup (OR 0.75, 95% CI 0.65–0.87, p = 0.0001). In conclusion, anti-VEGF agents can improve the PFS but not OS in glioblastoma patients. The current evidence is not satisfactory to declare a new therapeutic line. Further RCTs with sharply determined outcomes and assessment methods are required.

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Abbreviations

OS:

overall survival

PFS:

progression-free survival

VEGF:

vascular endothelial growth factor

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Author information

Authors and Affiliations

  1. Department of Pathology, The first Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China

    Qiuxiang Xiao

  2. Department of Neurosurgery, The first Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Ganzhou, 341000, Jiangxi, China

    Shaochun Yang, Guanfu Ding & Muyun Luo

Authors
  1. Qiuxiang Xiao
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  2. Shaochun Yang
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  3. Guanfu Ding
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  4. Muyun Luo
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Corresponding author

Correspondence to Muyun Luo.

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Appendices

Appendix 1

(((randomized controlled trial[pt] OR controlled clinical trial[pt]) OR(randomized OR randomized OR randomly OR placebo[tiab]) OR (trial[ti]) OR (“Clinical Trials as Topic”[MeSH Major Topic])) AND ((Glioblastoma[MeSH Terms]) OR Glioma*[Title/Abstract])) AND (((((Anti vascular endothelial growth factor [Title/Abstract]) OR (anti-VEGF[Title/Abstract]) OR (Bevacizumab*[Title/Abstract]) OR (ranibizumab*[Title/Abstract]) OR (cediranib*[Title/Abstract]))))

Appendix 2

#1 MeSH descriptor: [Glioblastoma] explode all trees

#2 “Glioma*”: ti,ab,kw

#3 #1 or #2

#4 Anti-VEGF: ti,ab,kw

#5 Bevacizumab: ti,ab,kw

#6 Ranibizumab: ti,ab,kw

#7 cediranib: ti,ab,kw

#8 Aflibercept: ti,ab,kw

#9#4 or #5 or #6 or #7 or #8

#10 #3 and #9

Appendix 3

#1 TS= Glioma*

#2 TS= Glioblastoma

#3 #1 OR #2

#4 TS= Anti vascular endothelial growth factor

#5 TS= anti-VEGF

#6 TS= Bevacizumab

#7 TS= ranibizumab

#8 TS= cediranib

#9 #4 OR #5 OR #6 OR #7 OR #8

#10 #3 AND #9

#11 TS=random*

#12 #10 AND #11

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Xiao, Q., Yang, S., Ding, G. et al. Anti-vascular endothelial growth factor in glioblastoma: a systematic review and meta-analysis. Neurol Sci 39, 2021–2031 (2018). https://doi.org/10.1007/s10072-018-3568-y

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  • DOI: https://doi.org/10.1007/s10072-018-3568-y

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