Reviews - Oncology
Vol. 97 No. 4 (2025)
https://doi.org/10.4081/aiua.2025.14659

Risk of urinary adverse effects of bevacizumab therapy in patients with ovarian cancer: a systematic review and meta-analysis

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Published: 24 December 2025
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Bevacizumab, ovarian cancer, urinary complications, proteinuria, meta-analysis, anti-angiogenic therapy, adverse drug events, gynecological malignancies

Authors

Mazen Karama
Urology Department, School of Medicine, Aden University, Aden, Yemen.
Mohammed Qaid
Nephrology Department, Al-Gomhoria Teaching Hospital, Aden, Yemen.
Adham Alkhammar
Urology Department, School of Medicine, Aden University, Aden, Yemen.
Farida Noman
Health Projects Manager, Non-Governmental Organization (NGO), Aden, Yemen.
Ahmed Karama
Surgical Department, Al-Gomhoria Teaching Hospital, Aden, Yemen.
Faisal Ahmed
fmaaa2006@yahoo.com
https://orcid.org/0000-0001-7188-2715
Urology Department, School of Medicine, Ibb University, Ibb, Yemen.

Background: Ovarian cancer is one of the most lethal malignancies affecting women, often diagnosed at advanced stages. Bevacizumab, a novel therapeutic agent, has recently demonstrated efficacy in the management of this disease. However, its use has been associated with various adverse effects reported in clinical trials. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of urinary complications linked to bevacizumab therapy in ovarian cancer patients.
Methods: This systematic review and meta-analysis involved a comprehensive search of databases such as PubMed, Scopus, Embase, Cochrane Library, Web of Science, and Google Scholar, covering studies up to October 2024. Eligible studies were randomized controlled trials (RCTs) that compared ovarian cancer patients undergoing bevacizumab treatment with those receiving other therapeutic options. The primary outcome was the relative risk (RR) of developing urinary complications, categorized based on disease grade and stage.
Results: A total of 11 interventional studies were ultimately included in the analysis. The relative risk (RR) of urinary complications in patients receiving bevacizumab in combination with chemotherapy, compared to the control group treated with chemotherapy without bevacizumab, was significantly elevated for key adverse events. The overall risk of complications, regardless of type, was 1.76 times higher (RR = 1.76, 95% CI: 1.18-2.61, p=0.005). Specific adverse events included a 6.13- fold increase in the risk of proteinuria (RR = 6.13, 95% CI: 2.84-13.25, p<0.001), a 5.03-fold increase for hyponatremia (RR = 5.03, 95% CI: 1.08-23.52, p=0.039), and a 2.41-fold increase for hyperkalemia (RR = 2.41, 95% CI: 0.57-10.22, p=0.232). Additionally, subgroup analysis based on grading revealed that the risk of proteinuria in the treatment group compared to controls was 6.35-fold higher for patients with grade ≤ 2 and 6.55-fold higher for those with grade ≥3.
Conclusions: This study demonstrated that the use of Bevacizumab in patients with ovarian cancer significantly increases the overall risk of urinary complications, particularly proteinuria. These findings could contribute to enhanced awareness, facilitating the early identification and management of these adverse effects.

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Risk of urinary adverse effects of bevacizumab therapy in patients with ovarian cancer: a systematic review and meta-analysis. (2025). Archivio Italiano Di Urologia E Andrologia, 97(4). https://doi.org/10.4081/aiua.2025.14659
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