Efficacy and safety of bevacizumab in the treatment of advanced or recurrent cervical cancer: a systematic review and a meta-analysis

Background: This meta-analysis aims to evaluate the safety and effectiveness of the combination of chemotherapy and bevacizumab versus chemotherapy alone in treating advanced or refractory cervical cancer (a/r CC), providing guidance for clinical practice. Methods: A computer search of studies on the combination of bevacizumab and chemotherapy was conducted up to 20 March 2024. Literature was screened and assessed based on inclusion and exclusion criteria and relevant data were extracted for analysis. Results: Ten studies were included. The meta-analysis showed that the overall survival (OS) of the platinum-paclitaxel plus bevacizumab group was significantly better than that of the traditional chemotherapy group (hazard ratio (HR) = 0.76, 95% confidence interval (CI): 0.68–0.85, p < 0.001; I2 = 17.2%). Progression-free survival (PFS) was also significantly improved in the combined group (HR = 0.59, 95% CI: 0.49–0.71, p < 0.001; I2 = 0.0%). The combined therapy group had higher rates of complete response (CR)(relative risk (RR) = 1.22, 95% CI: 1.00–1.47, p = 0.046) and partial response (PR) (RR = 1.38, 95% CI: 1.15–1.66, p = 0.001), while the incidence of progression disease (PD) was lower (RR = 0.43, 95% CI: 0.31–0.61, p < 0.001). No significant difference was found in stabilization disease (SD) between the groups (p = 0.998). However, the bevacizumab group exhibited a significantly higher incidence in terms of adverse events, including hypertension (p = 0.029), thrombosis (p < 0.01), and neutropenia (p = 0.011), while other side effects between the two groups, such as pain, gastrointestinal and genitourinary fistulas, and bleeding, showed no significant differences. Conclusion: The combination of bevacizumab and chemotherapy improves the survival and efficacy of patients with a/r CC compared to chemotherapy alone, though it is associated with a higher incidence of certain adverse events. The PROSPERO Registration: CRD42023451617.