Key result
Adding bevacizumab to chemotherapy linked to ~4-fold higher hypertension odds and increased ATE risk.
Why the study?
Bevacizumab is associated with infrequent, life-threatening side effects such as severe hypertension and thromboembolism, but the additive risk when combined with standard chemotherapy in metastatic colorectal cancer needed evaluation.
Does bevacizumab added to standard chemotherapy increase the risk of hypertension and thromboembolism in patients with metastatic colorectal cancer?
Meta-Analysis
Does bevacizumab added to standard chemotherapy increase the risk of hypertension and thromboembolism in patients with metastatic colorectal cancer?
Effect estimate: OR ~4 (HTN), OR >2 (ATE)
Adding bevacizumab to standard chemotherapy for metastatic colorectal cancer significantly increases the risk of severe hypertension and arterial thromboembolism.
Warrants routine BP and vascular monitoring with bevacizumab; confirms elevated hypertension and ATE risks across aggregated trials.
BACKGROUND: Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three-drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first-line standard therapies. BVZ is generally well tolerated; however, it is associated with infrequent, life-threatening side effects such as severe hypertension (HTN) (5%-18%), Grade ≥3 arterial thromboembolism (ATE) (2.6%), Grade ≥3 hemorrhagic events (1.2%-4.6%), and gastrointestinal perforation (0.3%-2.4%). This meta-analysis aims to evaluate the additive risk of BVZ-induced severe HTN and thromboembolism when BVZ is combined with a standard chemotherapy regime in patients with mCRC. METHODS: Our search was conducted from January 29, 2022, to February 22, 2022, through databases of PubMed, clinicaltrial.gov, EMBASE, Web of Science, and Cochrane Library. Data analysis from randomized controlled trials (RCTs) and clinical trials was conducted using Review Manager V.5.4, comparing BVZ-chemotherapy to chemotherapy only, focusing on cardiovascular AE such as HTN and arterial and venous thromboembolism. RESULTS: The analysis from 26 clinical trials and RCTs showed that the odds of HTN were about four times higher, and ATE subgroup analysis of 11 studies showed over two times higher odds of ATE in patients being treated with BVZ compared to the chemotherapy-only group. CONCLUSION: BVZ, when added to the standard chemotherapy regimen for mCRC, was associated with higher odds of developing HTN and thromboembolism, specifically ATE, than the chemotherapy-only group. Our findings are significant as they provide vital information in analyzing the risk-benefit ratio of adding BVZ to the standard chemotherapy regime in patients with mCRC, especially in patients with vascular comorbidities.
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Chitkara et al. (2023) conducted a meta-analysis in Metastatic colorectal cancer (mCRC). Bevacizumab with chemotherapy vs. Chemotherapy only was evaluated on Cardiovascular adverse events such as hypertension (HTN) and arterial and venous thromboembolism (OR ~4 (HTN), OR >2 (ATE)). Adding bevacizumab to standard chemotherapy in patients with metastatic colorectal cancer was associated with about four times higher odds of hypertension and over two times higher odds of ATE.
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