Risk of Arterial and Venous Thromboembolic Events with Bevacizumab, an Antibody against Vascular Endothelial Growth Factor A (VEGF-A): A Systematic Review and Meta-Analysis
Abstract- Introduction: Bevacizumab, a humanized antibody against VEGF, is effective within the treatment of patients with several cancers. However, like several therapeutic agents, important side effects such as arterial thromboembolism, venous thromboembolism, hypertension, neutropenia, proteinuria, and hemorrhage are related to bevacizumab. Thromboembolism is one of the leading causes of morbidity and mortality in patients with cancer. Considerations have arisen relating to the chance of venous and arterial thromboembolism with the novel antiangiogenic agent bevacizumab: a recombinant humanized monoclonal antibody to a vascular endothelial growth factor which is wide employed in cancer treatment. Methodology: We performed a meta-analysis of published clinical trials of bevacizumab to quantify the risk of Thromboembolic events. Fourteen studies following PRISMA guidelines and matching inclusion and exclusion criteria were collected in which a group of patients was either treated with Bevacizumab and concurrent chemotherapy and another group treated with Placebo and the same chemotherapy. We calculated the Relative risk (RR). P<0.05 was considered statistically significant. We used R version 3.3.1 (The R Foundation for Statistical Computing) for the analysis. Results: Total 12,280 patients were included. Bevacizumab was associated with an increased risk of Arterial Thromboembolic Events at a high dose (R.R=1.6002; 95% C.I: 1.604 to 2.2066) and Venous Thromboembolic Events at high dose (R.R=1.2433; 95% C.I:1.0375 to 1.4448). At the low dose no significant risk was seen.
