The benefits and pitfalls of adding bevacizumab to neoadjuvant chemotherapy for advanced ovarian cancer: a meta-analysis

To appraise the efficacy and toxicity of adding bevacizumab to neoadjuvant chemotherapy (NACT) for advanced-stage ovarian cancer (AOC). All studies regarding neoadjuvant bevacizumab for AOC published in PubMed, EMBASE, Scopus and Web of Science from 1 November 2010 to 31 December 2024 were retrieved and reviewed. Three randomized clinical trials, five retrospective cohort studies, and six case series were eligible, including 687 patients receiving bevacizumab-NACT and 1482 patients receiving standard-NACT. There were no significant differences between the bevacizumab-NACT group and the standard-NACT group in the rates of interval debulking surgery implementation, achieving complete cytoreduction, wound complication, thrombogenesis, and infections (grade ≥3). The rate of achieving optimal cytoreduction in bevacizumab-NACT group was significantly higher than that in standard-NACT group (RR: 1.17, 95% CI: 1.02 to 1.34, P = 0.02; I² = 30%). However, the bevacizumab-NACT group exhibited an increased risk of gastrointestinal perforation (RR: 6.97, 95% CI: 1.28 to 37.99, P = 0.02; I² = 0%), with an incidence of 1.2% (95% CI: 0% to 3.6%; I² = 34%). Adding bevacizumab to NACT for AOC can enhance the feasibility of optimal cytoreduction, rather than complete cytoreduction. However, bevacizumab-NACT increased the risk of gastrointestinal perforation. www.crd.york.ac.uk/prospero identifier is CRD42024566484.