Turkish Neurosurgery
Chemotherapy for Adults with Malignant Glioma: A Systematic Review and Network Meta-analysis
Wang Wen1, Shi Guang2, Ma Binbin1, Hao Xiangcheng1, Dong Xin3, Zhang Bo1
1The Second Hospital of Dalian Medical University, Neurosurgery, Dalian,
2The Second Hospital of Hebei Medical University, Neurosurgery, Shijiazhuang,
3Tongliao City Hospital, Neurosurgery, Tongliao,
DOI: 10.5137/1019-5149.JTN.15462-15.0

Aim:Malignant glioma is the most common primary brain tumor in adults and the survival rate has remained very low. Thus, determining the optimal treatment for patients can be challenging. To compare the efficacy of common therapies, we performed network meta-analysis to estimate the efficacy and safety among procarbazine, lomustine, vincristine, temozolomide, bevacizumab plus temozolomide, and placebo for patients with malignant glioma.Material and Methods:Relevant studies (as of March, 2014) were identified by searching PubMed, Embase, and Central databases. The primary endpoint of the analysis was the overall survival (OS) and progression-free survival (PFS) of glioma patients. Results:Nine trials with a total of 3472 patients were included in our network meta-analyses. Compared with placebo, bevacizumab plus temozolomide was associated with the highest estimates of OS and PFS for 12 and 24 months (12 month OS odds ratio [OR]: 2.44; 95% credibility interval [CrIs]: 0.76-9.69; 24 month OS OR: 2.56; 95% CrIs: 1.12–5.24; 12 month PFS OR: 6.76; 95% CrIs: 2.80–17.34; 24 month PFS OR: 3.69; 95% CrIs: 0.62–28.63). However, bevacizumab plus temozolomide did not significantly improve OS or PFS compared to temozolomide alone. Conclusion: The results of this analysis suggest that bevacizumab plus temozolomide combination therapy is not significantly more effective than temozolomide alone in improving survival of glioma patients. Moreover, bevacizumab was associated with higher hematologic toxicities. Based on the results, we suggest that bevacizumab should be used with caution in glioma patients. Additional randomized controlled trials are required to confirm this finding.

Corresponding author : Zhang Bo