Analysis on the efficacy and safety of chemotherapy combined with or without bevacizumab after CRS+HIPEC in patients with malignant peritoneal mesothelioma: a single-center retrospective study

Our plain-English summary of Analysis on the efficacy and safety of chemotherapy combined with or without bevacizumab after CRS+HIPEC in patients with malignant peritoneal mesothelioma: a single-center retrospective study, by Z.R. Yang, X.L. Liang, X.B. Li, et al (Frontiers in Oncology, 2026).

The study

• Authors: Z.R. Yang, X.L. Liang, X.B. Li, X.J. Zhang, H.L. Wu, Y.D. Su, Y. Li, S.L. An
• Journal: Frontiers in Oncology
• Published: 2026;16:1733967
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To investigate the efficacy and safety of pemetrexed/platinum-based chemotherapy combined with or without bevacizumab after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of patients with malignant peritoneal mesothelioma (MPM).

Methods: A retrospective non-randomized study was performed on 205 MPM patients treated with CRS+HIPEC at our institution. A total of 97 eligible patients were analyzed: 58 patients who received postoperative chemotherapy combined with bevacizumab (C&B) and 39 patients who received chemotherapy alone (C) were divided into a study group and a control group, respectively. The patients were also divided into the bevacizumab-exposed subgroup and the bevacizumab-unexposed subgroup based on whether they had a history of bevacizumab infusion. Clinicopathological data and follow-up information were statistically analyzed. Independent prognostic factors were identified via survival analysis, and the safety of combination therapy was assessed via adverse event analysis.

Results: As of the follow-up cutoff date of July 1, 2025, in both the subgroups with and without a history of bevacizumab infusion, there was no statistically significant difference between the control and study groups in baseline pathological characteristic parameters (p > 0.05). Survival analysis revealed that in the subgroup of patients with a history of bevacizumab infusion, the difference in median overall survival (mOS) between the control and study groups was statistically significant (31.9 months vs. NR; p = 0.031), and the difference in median disease-free survival (mDFS) between the control and study groups was statistically significant (12.5 months vs. NR; p = 0.001); in the subgroup of patients without a history of bevacizumab infusion, the difference in mOS between the control and study groups was also statistically significant (20.5 months vs. NR; p = 0.001), and the difference in mDFS between the control and study groups was statistically significant (13.2 vs. 36.2 months; p = 0.001). The Cox regression model found that postoperative C&B was an independent prognostic factor (p = 0.009, HR = 0.081, 95% CI: 0.012-0.526) in the subgroup with a history of bevacizumab infusion, and the Ki-67 index (p = 0.043, HR = 2.563, 95% CI: 1.029-6.386) and postoperative C&B were independent prognostic factors (p = 0.01, HR = 0.086, 95% CI: 0.032-0.232) in the subgroup with no bevacizumab treatment history. A total of 101 cases of grade 1~2 adverse events in the study group were revealed via adverse event analysis, with common events including nausea/vomiting, fatigue, leukopenia/neutropenia, thrombocytopenia, anemia, abnormal liver function, hypertension, and proteinuria. There were four cases with grade 3 adverse events, mainly leukopenia/neutropenia, hypertension, and proteinuria. In the control group, there were 84 cases of grade 1~2 adverse events, and three cases of grade 3 adverse events were observed.

Conclusion: Our exploratory findings suggest that bevacizumab combined with pemetrexed/platinum-based chemotherapy may be a therapeutic option for MPM patients after CRS+HIPEC; however, a prospective, randomized controlled clinical study is needed to validate our findings.

Copyright © 2026 Yang, Liang, Li, Zhang, Wu, Su, Li and An.

In plain English

This single-center, retrospective, non-randomized study from Beijing Shijitan Hospital in China looked at patients with malignant peritoneal mesothelioma treated with cytoreductive surgery and heated chemotherapy inside the abdomen (CRS+HIPEC) between August 2016 and February 2025. Of 205 patients, 97 were analyzed. After surgery, 58 received pemetrexed and platinum chemotherapy plus bevacizumab, and 39 received chemotherapy alone. Patients with good economic conditions, no bleeding risk and no history of hypertension or proteinuria were more inclined to receive bevacizumab. Patients were analyzed separately by whether they had received bevacizumab before. In both subgroups, median overall survival differed significantly between the two treatment groups. It was 31.9 and 20.5 months in the chemotherapy-alone groups and was not reached in the bevacizumab groups. The bevacizumab group had 101 grade 1 to 2 and four grade 3 adverse events. The chemotherapy-alone group had 84 and three. The authors concluded that bevacizumab with this chemotherapy may be a treatment option after CRS+HIPEC, but that a prospective randomized trial is needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center retrospective non-randomized study
• Who was studied: 205 patients with malignant peritoneal mesothelioma (MPM) who had CRS+HIPEC at Beijing Shijitan Hospital, China, from August 2016 to February 2025. 97 were eligible: 58 in the chemotherapy plus bevacizumab (study) group and 39 in the chemotherapy-alone (control) group. Subgroups: 29 with a history of bevacizumab infusion (10 control, 19 study) and 68 without (29 control, 39 study).
• Exposure: Postoperative pemetrexed plus platinum chemotherapy, with or without bevacizumab. Patients with good economic conditions, no bleeding risk and no history of hypertension and proteinuria were more inclined to receive bevacizumab. This is a treatment study; the article does not discuss asbestos exposure.
• Main results:
  • Subgroup with a history of bevacizumab infusion: median overall survival was 31.9 months in the control group versus not reached in the study group (p = 0.031).
  • Subgroup with a history of bevacizumab infusion: median disease-free survival was 12.5 months in the control group versus not reached in the study group (p = 0.001).
  • Subgroup without a history of bevacizumab infusion: median overall survival was 20.5 months in the control group versus not reached in the study group (p = 0.001).
  • Subgroup without a history of bevacizumab infusion: median disease-free survival was 13.2 months in the control group versus 36.2 months in the study group (p = 0.001).
  • Cox regression, subgroup with a history of bevacizumab infusion: postoperative chemotherapy plus bevacizumab was an independent prognostic factor (HR = 0.081, 95% CI 0.012 to 0.526, p = 0.009).
  • Cox regression, subgroup without a history of bevacizumab infusion: the Ki-67 index (HR = 2.563, 95% CI 1.029 to 6.386, p = 0.043) and postoperative chemotherapy plus bevacizumab (HR = 0.086, 95% CI 0.032 to 0.232, p = 0.01 in the text) were independent prognostic factors.
  • Adverse events: study group (n = 58) had 101 grade 1 to 2 and four grade 3 events. Control group (n = 39) had 84 grade 1 to 2 and three grade 3 events. The authors described the incidence as similar between groups.
  • No grade 4 adverse events occurred in either group.
• The authors' conclusion: The authors concluded that their exploratory findings suggest bevacizumab combined with pemetrexed/platinum-based chemotherapy may be a therapeutic option for MPM patients after CRS+HIPEC, and that a prospective, randomized controlled clinical study is needed to validate this.
• Limitations the authors state:
  • The study was single-center, retrospective and non-randomized, so the evidence is bounded and has limited extrapolation.
  • The Ki-67 cutoff of more than 9% came from the team's earlier work and may not be generalizable.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Bevacizumab, HIPEC, Peritoneal Mesothelioma, Pemetrexed (Alimta), Cytoreductive Surgery, Median Overall Survival, Disease-Free Survival.

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