Efficacy and safety of anti-angiogenesis medicines for advanced soft tissue sarcoma: a meta-analysis

BACKGROUND: Surgery-based treatment is the standard method for the early-stage soft tissue sarcoma (STS) with relatively good clinical outcome. However, the recurrence and metastasis decrease the survival of STS, regardless of surgery, radiotherapy, and chemotherapy. On the other hand, anti-angiogenesis treatments for STS have been clinically applied in recent years. To evaluate the safety and efficacy of anti-angiogenesis medicines for the treatment of advanced STS, we conducted a meta-analysis. METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, Excerpta Medica Database, and China National Knowledge Infrastructure from inception to September 5, 2019. And finally, nine studies with 1,230 patients were included after rigorous screening. The endpoints included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse reactions (AEs). And we analyzed them with the risk ratio (RR) or the hazard ratio (HR). Moreover, heterogeneity and sensitivity were also analyzed. RESULTS: The pooled data showed that anti-angiogenesis medicines significantly benefited ORR [risk ratio (RR) =2.16, 95% CI: 1.47–3.17, P<0.001], and DCR (RR =1.68, 95% CI: 1.49–1.89, P<0.001), respectively, and improved the PFS (HR =0.50, 95% CI: 0.41–0.59, P<0.001), and OS (HR =0.77, 95% CI: 0.63–0.95, P<0.05), respectively. However, as for grade III or higher acute AEs, the antiangiogenic treatment increased morbidities of hypertension (RR =4.88, P<0.005), and diarrhea (RR =3.98, P=0.021) compared to the control group. And no significant difference was found in bone marrow inhibition, vomiting, anemia, and mucositis. CONCLUSIONS: Anti-angiogenesis treatments are beneficial in short-term efficacy and long-term survival for the recurrence and metastasis of STS, and the AEs are tolerable.