title: Chemotherapy for Adults with Malignant Glioma: A Systematic Review and Network Meta-Analysis.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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. Bevacizumab should be used with caution in glioma patients. Additional randomized controlled trials are required to confirm this finding.
authors.affiliation: The Second Hospital of Dalian Medical University, Department of Neurosurgery, Dalian, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.forename: Guang
authors.initials: G
authors.lastname: Shi
authors.forename: Binbin
authors.initials: B
authors.lastname: Ma
authors.forename: Xiangcheng
authors.initials: X
authors.lastname: Hao
authors.forename: Xin
authors.initials: X
authors.lastname: Dong
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy*; D018572:Disease-Free Survival; D005910:Glioma / Q000188:drug therapy*; D006801:Humans
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents