Controversial Role of Bevacizumab in the Development of Venous Thromboembolic Events

read the article by Hurwitz et al 1 on the venous thromboembolic events (VTEs) with chemotherapy plus bevacizumab in patients with cancer that was based on a meta-analysis of individual patient data with great interest. We would like to make three comments that are relevant to the conclusion of the study, which is not consistent with our previous analysis. irst, the overall conclusion of bevacizumab's effect on VTEs depends on the studies included for the meta-analysis. This study included 10 randomized controlled clinical trials, which may be a small fraction of total bevacizumab trials. The article did not mention how many studies the authors had screened before the final selection of these trials. The difference in the number of included trials between this study and our previous meta-analysis 2 is substantial; although the two meta-analyses shared the same eight studies, they differed in a total of nine trials; the current study had added two new studies by Miles et al 3 and Van Cutsem et al 4 with a calculated summary risk ratio of 0.82 (95% CI, 0.60 to 1.11) and did not have seven other trials with asummaryrelativeriskof1.27(95%CI,0.94to1.73)whichwereincluded in our study. 2 Thus, the determination of overall RR by this study will be most likely underestimated by the addition and exclusion of these studies.