Adverse effects and use of bevacizumab in patients with glioblastoma. A systematic review and meta-analysis

Background: Glioblastoma (GBM) is a type of tumor originating from the glial brain cells, 21 the astrocytes, thus corresponding to the astrocytomas. Bevacizumab (BV) as a treatment for GBM. 22 BV is the active ingredient in the drugs Avastin® , Alymsys® , Mvasi® and ZiraBev® . It is currently 23 approved as second-line treatment for GBM recurrence in combination with radiotherapy, and as 24 first-line treatment for other cancers, including advanced colorectal cancer, metastatic breast cancer 25 and advanced non-small cell lung cancer. The objective of this systematic review was to analyze the 26 scientific evidence from the science-based literature on the therapeutic effect and adverse effects of 27 the drug BV in patients with GBM or GBM multiforme. Methods: We systematically searched elec- 28 tronic databases for the literature search, including MEDLINE (via PubMed), SCOPUS, Google 29 scholar, the Cumulative Index to Nursing and Allied Health Literature and Web of Science data- 30 bases, covering records from the earliest time to December 2024. Randomized or controlled clinical 31 trials that have been published in English or Spanish were included. The following keywords were 32 used in different combinations: 'Bevacizumab therapy', 'Bevacizumab pharmaceutical', 'Glio- 33 blastoma', 'Glioma', and 'multiform glioblastoma'. Results: The use of glioblastoma has been ex- 34 tensively studied by the scientific literature, the effects have been beneficial in symptom control, 35 regarding the adverse effects of BV are varied for different types of carcinomas, which is why it has 36 already been defined that there are adverse effects to be taken into consideration, in the meta-anal- 37 ysis of adverse effects, we have found 14 adverse effects to which we have been able to estimate the 38 prevalence of adverse effects with an average of 19% (CI: 4 to 44%), being the most important vas- 39 cular adverse effect thromboembolism and with a greater number of complications for patients with 40 GBM, finally the most common adverse effects are nausea, vomiting, fatigue and hypertension. 41 Conclusion: While the beneficial properties of this pharmacological therapy have been observed, 42 its adverse effect profile requires constant evaluation, as it includes vascular, blood and sympto- 43 matic adverse effects, which must be analyzed on a case-by-case basis and with great attention, 44 especially in more serious complications such as thromboembolic events