What type of study is this?

This is a Systematic Review study (also classified as: Meta-Analysis).

October 7, 2025Open Access

Neoadjuvant Bevacizumab in Newly Diagnosed, Surgically Resectable Glioblastoma: A Systematic Review and Meta-Analysis of Survival and Functional Outcomes

Key Points

Neoadjuvant bevacizumab did not significantly improve overall survival or progression-free survival in glioblastoma patients, indicating limited effectiveness.
Pooled hazard ratios for overall survival and progression-free survival were both 0.72, with low heterogeneity observed across evaluated studies.
Systematic review analyzed 13 studies, including randomized and non-randomized trials, focusing on survival and functional outcomes in glioblastoma.
Findings highlight the need for well-designed multicenter RCTs due to current limitations in sample sizes and methodological quality.

Abstract

Background: Glioblastoma (GBM) remains one of the most aggressive primary brain tumors, with limited survival despite maximal safe resection and chemoradiotherapy. Neoadjuvant bevacizumab (BEV) has been proposed to reduce peritumoral edema, improve functional status, and potentially enhance progression-free survival (PFS). However, its survival benefit in newly diagnosed, surgically resectable GBM remains unclear. Objective: To systematically review and quantitatively synthesize the evidence on neoadjuvant BEV in adult patients with newly diagnosed, resectable GBM, focusing on survival and functional outcomes. Methods: Following PROSPERO registration (CRD420251078761), we searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to July 20, 2025, without language restrictions. Eligible randomized trials, non-randomized trials, and cohort studies compared neoadjuvant BEV (alone or with other therapies) to standard care without BEV. Primary outcomes were overall survival (OS) and PFS; secondary outcomes included Karnofsky Performance Status (KPS), steroid use, radiological response, and biomarkers. Data were pooled using a random-effects model. Results: Thirteen studies (2 RCTs, 7 non-randomized trials, 4 cohorts) met the inclusion criteria; four (n=751) were eligible for meta-analysis. Pooled HR for OS was 0. 72 (95% CI: 0. 42-1. 25, p=0. 246) and for PFS was 0. 72 (95% CI: 0. 42-1. 22, p=0. 220), both with low heterogeneity (I²=0%). Functional outcomes suggested improved KPS and reduced steroid dependence, but certainty was low. Biomarker and radiological findings were inconsistent. Conclusions: Neoadjuvant BEV in resectable GBM does not significantly improve OS or PFS but may offer symptomatic and functional benefits. Current evidence is limited by small sample sizes, heterogeneous protocols, and low methodological quality. Well-designed multicenter RCTs are warranted.

Neoadjuvant Bevacizumab in Newly Diagnosed, Surgically Resectable Glioblastoma: A Systematic Review and Meta-Analysis of Survival and Functional Outcomes

Key Points

Abstract

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