Intracavitary perfusion with bevacizumab plus cisplatin versus cisplatin alone for malignant pleural effusion in lung cancer patients: a meta-analysis of randomized controlled trials.

objectiveIntracavitary perfusion with bevacizumab plus cisplatin shows more clinical benefits versus cisplatin alone in lung cancer patients with malignant pleural effusion (MPE), while there lacks a comprehensive assessment. This meta-analysis reviewed data from randomized controlled trials (RCTs) to comprehensively evaluate the efficacy and safety of intracavitary perfusion with bevacizumab plus cisplatin in these patients.

methodsCochrane Library, Web of Science, PubMed, Wanfang, CNKI, and VIP databases were used for study searching until July 2024. Total efficacy rate (defined as complete response and partial response), pleural fluid vascular endothelial growth factor (VEGF) after treatment, and adverse reactions were analyzed.

resultsTwenty RCT studies involving 1316 patients were included. Elevated total efficacy rate [relative risk (RR) (95% confidence intervals (CI)): 1.48 (1.37, 1.60), P < 0.001] and reduced pleural fluid VEGF after treatment [standardized mean difference (95% CI): -4.28 (-4.87, -3.69) pg/mL, P < 0.001] were observed in bevacizumab + cisplatin group versus cisplatin group. The incidence of any adverse reactions [RR (95% CI): 0.66 (0.47, 0.93), P = 0.019], and the incidences of nausea and vomiting [RR (95% CI): 0.80 (0.65, 0.98), P = 0.030] and rash [RR (95% CI): 0.72 (0.54, 0.95), P = 0.023] were reduced in bevacizumab + cisplatin group versus cisplatin group. However, the incidences of other specific adverse reactions were non-differential between groups. There was no publication bias in any outcomes. Sensitivity analyses revealed relatively high robustness.

conclusionThis RCT-based meta-analysis shows a favorable efficacy and safety profile of intracavitary perfusion with bevacizumab plus cisplatin, which may be an alternative treatment modality for MPE in lung cancer patients.