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To the Editor: The meta-analysis assessing the risk of venous thromboembolism (VTE) with bevacizumab in cancer patients by Dr Nalluri and colleagues¹ carefully reviewed 15 well-conducted randomized controlled trials (RCTs) comparing bevacizumab therapy with placebo. However, because the authors failed to distinguish between incidence per treatment episode and incidence per unit of time (the more relevant statistic), their conclusions may be erroneous. In oncology clinical trials such as those reviewed, patients are generally not treated for a predetermined fixed period of time; rather, they are treated until their cancer shows evidence of progression on computed tomographic scans, at which time the patient is removed from the trial and further adverse events are not recorded beyond 30 days after the end of treatment.

Because bevacizumab is a beneficial oncology drug, the patients in these trials often stayed on treatment with bevacizumab much longer than placebo, giving them more time to develop . . . [Full Text of this Article]

David R. Minor, MD
minord@sutterhealth.org
California Pacific Medical Center
San Francisco

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