A meta-analysis on the effectiveness and safety of FOLFOX plus bevacizumab for colorectal cancer treatment

Objective Colorectal cancer is a globally prevalent malignancy of the digestive system. This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of bevacizumab combined with the FOLFOX regimen for the treatment of colorectal cancer, with the aim of informing clinical management and improving patient outcomes. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. PubMed, EMBASE, Web of Science, CNKI, and WanFang Database were systematically searched from database inception to April 30, 2023. Database-specific search strategies were developed using Boolean operators, controlled vocabulary terms where applicable, and free-text keywords related to colorectal cancer, bevacizumab, and FOLFOX-based chemotherapy. Reference lists of relevant studies were manually screened, and grey literature sources and trial registries were also checked when feasible. No language restrictions were applied during the initial search; studies published in English or Chinese were considered for inclusion. Randomized controlled trials comparing FOLFOX plus bevacizumab with FOLFOX alone in patients with advanced or metastatic colorectal cancer were included. Study selection, data extraction, and quality assessment were performed independently by two reviewers, and meta-analysis was conducted using RevMan 5.4 software. Results Eleven randomized controlled trials were included. The pooled analysis showed that bevacizumab plus FOLFOX significantly improved ORR and DCR compared with FOLFOX alone. No significant differences were observed in gastrointestinal reactions, leukopenia, liver injury, neurotoxicity, or hypertension in the overall pooled analysis, although substantial heterogeneity was noted for hypertension and was addressed using a random-effects model. Sensitivity analyses suggested that the main efficacy findings were relatively robust. Conclusion Bevacizumab combined with the FOLFOX regimen may improve short-term efficacy outcomes, particularly ORR and DCR, in patients with advanced or metastatic colorectal cancer. However, the evidence for long-term survival benefit and quality-of-life improvement remains insufficient.