Risk/benefit profile of bevacizumab in metastatic colon cancer: A systematic review and meta-analysis

Elena Galfrascoli, Sheila Piva, Michela Cinquini, Antonio Rossi, Nicla La Verde, Annalisa Bramati, Anna Moretti, Andrea Manazza, Giovanna Damia, Valter Torri, Gaetana Muserra, Gabriella Farina, Marina Chiara Garassino

Research output: Contribution to journalArticle


Background: Bevacizumab, an anti vascular endothelial growth factor antibody is licensed in several tumours and widely used in colorectal cancer. However, bevacizumab has several adverse effects which may appear unexpectedly and differ according to the tumour. Aims: The aim of this work is to quantify the overall risk of bevacizumab-related side effects in patients affected by advanced colorectal cancer and to compare them with its overall benefit. Methods: We performed a systematic review and meta-analysis investigating bevacizumab in metastatic colorectal cancer. Our primary endpoint was safety and secondary endpoints were overall survival and progression-free survival. The relative risks for side effects were calculated with their 95% confidence interval using the inverse of variance method. For statistically significant relative risks, number needed to harm were calculated. Results: We retrieved six out of 17 eligible papers encompassing 3385 patients. Only hypertension (relative risk 2.98 95% confidence interval 2.32-3.84), gastrointestinal perforations (relative risk 5.04 95% confidence interval 1.72-14.79) and bleeding (relative risk 2.07 95% confidence interval 1.19-3.62) were significantly increased. Bevacizumab significantly improved both overall survival (HR 0.80 95% confidence interval 0.71-0.91) and progression-free survival (hazard ratio (HR) 0.62 95% confidence interval 0.52-0.74). Number needed to treat for overall survival is 12, whilst number needed to harms ranges from 2 to 14.286. Conclusion: These results show that the benefits of the treatment with bevacizumab outweigh the toxicity that may occur: enough to justify its use in advanced colorectal cancer.

Original languageEnglish
Pages (from-to)286-294
Number of pages9
JournalDigestive and Liver Disease
Issue number4
Publication statusPublished - Apr 2011


  • Bevacizumab
  • Colorectal cancer
  • Meta-analysis
  • Toxicity

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Fingerprint Dive into the research topics of 'Risk/benefit profile of bevacizumab in metastatic colon cancer: A systematic review and meta-analysis'. Together they form a unique fingerprint.

  • Cite this

    Galfrascoli, E., Piva, S., Cinquini, M., Rossi, A., La Verde, N., Bramati, A., Moretti, A., Manazza, A., Damia, G., Torri, V., Muserra, G., Farina, G., & Garassino, M. C. (2011). Risk/benefit profile of bevacizumab in metastatic colon cancer: A systematic review and meta-analysis. Digestive and Liver Disease, 43(4), 286-294. https://doi.org/10.1016/j.dld.2010.10.010