Bevacizumab Plus Re-irradiation Therapy vs. Bevacizumab Monotherapy in the Treatment of Recurrent Glioblastomas: A Systematic Review and Meta-analysis
Beenish Sabir1, Haris Mumtaz Malik1, Abdullah Bin Kamran1, Amina Khan1, Muhammad Nabeel Saddique2, Fatima Faraz1, Hammad Javaid2, Muhammad Moiz Javed3, Afifa Kulsoom1, Mashaal Raheman1, Inbsaat Iqbal2, Shafaq Saleem1, Aiman Amir1
1Rawalpindi Medical University, 2King Edward Medical University, 3Geisinger Medical Center
Objective:
This study evaluates the efficacy of re-irradiation combined with bevacizumab compared to bevacizumab alone in treating recurrent glioblastoma.
Background:
Glioblastomas are the most aggressive primary brain tumors, characterized by high recurrence rates. Standard treatment involves maximal surgical resection, followed by chemotherapy and radiotherapy. Bevacizumab has emerged as a promising therapeutic agent when combined with re-irradiation for recurrent glioblastomas.
Design/Methods:
A comprehensive literature review was conducted using PubMed, Cochrane, Embase, and Clinicaltrials.gov from inception until January 2025. A random-effects model of meta-analysis was applied using the Mantel-Haenszel method to synthesize hazard ratios (HR) for dichotomous outcomes with 95% confidence intervals. The I² and χ² statistics were used to evaluate interstudy heterogeneity. All analyses were performed using R Studio.
Results:
This meta-analysis included four studies with a total of 390 patients (205 vs 185). We found significantly improved progression-free survival (HR 2.00, 95% CI: [1.64-2.45]), p < 0.0.1, I2=0%) and overall survival (HR 2.00, 95% CI: [1.45-2.77]), p < 0.0.1, I2=58%) in bevacizumab combined with re-irradiation compared to bevacizumab monotherapy.
Conclusions:
The combination of re-irradiation and bevacizumab provides better treatment benefits and disease control compared to bevacizumab alone in treating recurrent glioblastoma. Our findings are limited by a small sample size, and we suggest conducting more robust studies with larger samples to understand the full potential of these modalities.
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