***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the current study was the investigation of the value of bevacizumab + 5‐fluorouracil(5–FU)/folinic acid in patients with advanced colorectal cancers who have exhausted st and ard chemotherapy options Objective : The objective of this phase III trial was to compare chemotherapy combined with bevacizumab versus chemotherapy alone in the treatment of patients with advanced colorectal cancer . Methods : From September 2004 till September 2008 , 222 treatment-naive patients were enrolled and divided into 2 arms : 114 arm A patients were treated with leucovorin , 5-fluorouracil plus irinotecan in combination with bevacizumab , and 108 arm B patients were treated as above without bevacizumab .  All patients were stage IV with histologically confirmed adenocarcinoma . Results : The median overall survival of arm A patients was 22.0 months ( 95 % CI : 18.1–25.9 ) and 25.0 months ( CI : 18.1–31.9 ) for arm B patients . There was no statistically significant difference between the 2 arms ( p = 0.1391 ) . No statistically significant difference between the 2 arms regarding the response ratewas observed : partial response , 42 patients ( 36.8 % ) and 38 patients ( 35.2 % ) for arms A and B , respectively . Hematologic toxicity did not differ in the comparison of the 2 arms . Nonhematologic toxicity in arm A involved hypertension in 23 ( 20.2 % ) of the patients and proteinuria in 7 ( 6.1 % ) ; 3 patients experienced hemorrhage and 1 patient intestinal perforation . None of these side effects was observed in arm B patients . Conclusion : No statistically significant difference in median overall survival in patients with advanced colorectal cancer treated with bevacizumab plus a combination therapy ( arm A ) and those treated with the combination only , without bevacizumab ( arm B ) , was observed Doctors , patients , and other decision makers need access to the best available clinical evidence , which can come from systematic review s , experimental trials , and observational research . Despite method ological challenges , high- quality observational studies have an important role in comparative effectiveness research because they can address issues that are otherwise difficult or impossible to study . In addition , many clinical and policy decisions do not require the very high levels of certainty provided by large , rigorous r and omized trials . This paper provides insights and a framework to guide good decision making that involves the full range of high- quality comparative effectiveness research techniques , including observational research Introduction Insulin analog glargine ( GLA ) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control . Studies have shown that a decrease in the frequency of hypoglycemic episodes improves the quality of life ( QoL ) of diabetic patients . However , there are appreciable acquisition cost differences between different insulins . Consequently , there is a need to assess their impact on QoL to provide future guidance to health authorities . Method A systematic review of multiple data bases including Medline , LILACS , Cochrane , and EMBASE data bases with several combinations of agreed terms involving r and omized controlled trials and cohorts , as well as manual search es and gray literature , was undertaken . The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed . Results Eight studies were eventually included in the systematic review out of 634 publications . Eight different QoL instruments were used ( two generic , two mixed , and four specific ) , in which the Diabetes Treatment Satisfaction Question naire ( DTSQ ) was the most used . The systematic review did not consistently show any significant difference overall in QoL scores , whether as part of subsets or combined into a single score , with the use of GLA versus neutral protamine Hagedorn ( NPH ) insulin . Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin , but not using the Well-being Inquiry for Diabetics ( WED ) scale . However , none of the cohort studies scored a maximum on the Newcastle – Ottawa scale for quality , and they generally were of moderate quality with bias in the studies . Conclusion There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated . In view of this , we believe the current price differential between GLA and NPH insulin in Brazil can not be justified by these findings BACKGROUND Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation , but it is not curative . METHODS We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance ( CanCORS ) study ( a national , prospect i ve , observational cohort study ) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic ( stage IV ) lung or colorectal cancer . We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical , sociodemographic , and health-system factors associated with this expectation . Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records . RESULTS Overall , 69 % of patients with lung cancer and 81 % of those with colorectal cancer did not report underst and ing that chemotherapy was not at all likely to cure their cancer . In multivariable logistic regression , the risk of reporting inaccurate beliefs about chemotherapy  was higher among patients with colorectal cancer , as compared with those with lung cancer ( odds ratio , 1.75 ; 95 % confidence interval [ CI ] , 1.29 to 2.37 ) ; among nonwhite and Hispanic patients , as compared with non-Hispanic white patients ( odds ratio for Hispanic patients , 2.82 ; 95 % CI , 1.51 to 5.27 ; odds ratio for black patients , 2.93 ; 95 % CI , 1.80 to 4.78 ) ; and among patients who rated their communication with their physician very favorably , as compared with less favorably ( odds ratio for highest third vs. lowest third , 1.90 ; 95 % CI , 1.33 to 2.72 ) . Educational level , functional status , and the patient 's role in decision making were not associated with such inaccurate beliefs about chemotherapy . CONCLUSIONS Many patients receiving chemotherapy for incurable cancers may not underst and that chemotherapy is unlikely to be curative , which could compromise their ability to make informed treatment decisions that are consonant with their preferences . Physicians may be able to improve patients ' underst and ing , but this may come at the cost of patients ' satisfaction with them . ( Funded by the National Cancer Institute and others . ) PURPOSE In a previous study of treatment for advanced colorectal cancer , the LV5FU2 regimen , comprising leucovorin ( LV ) plus bolus and infusional fluorouracil ( 5FU ) every 2 weeks , was superior to the st and ard North Central Cancer Treatment Group/Mayo Clinic 5-day bolus 5FU/LV regimen . This phase III study investigated the effect of combining oxaliplatin with LV5FU2 , with progression-free survival as the primary end point . PATIENTS AND METHODS Four hundred twenty previously untreated patients with measurable disease were r and omized to receive a 2-hour infusion of LV ( 200 mg/m(2)/d ) followed by a 5FU bolus ( 400 mg/m(2)/d ) and 22-hour infusion ( 600 mg/m(2)/d ) for 2 consecutive days every 2 weeks , either alone or together with oxaliplatin 85 mg/m(2 ) as a 2-hour infusion on day 1 . RESULTS Patients allocated to oxaliplatin plus LV5FU2 had significantly longer progression-free survival ( median , 9.0 v 6.2 months ; P = .0003 ) and better response rate ( 50.7 % v 22.3 % ; P = .0001 ) when compared with the control arm . The improvement in overall survival did not reach significance ( median , 16.2 v 14.7 months ; P = . 12 ) . LV5FU2 plus oxaliplatin gave higher frequencies of National Cancer Institute common toxicity criteria grade 3/4 neutropenia ( 41 . 7 % v 5.3 % of patients ) , grade 3/4 diarrhea ( 11.9 % v 5.3 % ) , and grade 3 neurosensory toxicity ( 18.2 % v 0 % ) , but this did not result in impairment of quality of life ( QoL ) . Survival without disease progression or deterioration in global health status was longer in patients allocated to oxaliplatin treatment ( P = .004 ) . CONCLUSION The LV5FU2-oxaliplatin combination seems beneficial as first-line therapy in advanced colorectal cancer , demonstrating a prolonged progression-free survival with acceptable tolerability and maintenance of Key Points Question Does the treatment effect size differ between overall survival and progression-free survival for PD-1 ( programmed cell death 1 ) inhibitors used in patients with advanced solid tumors , and are overall survival and progression-free survival correlated ? Findings This meta- analysis of 12 r and omized clinical trials found no significant correlation between overall survival and progression-free survival in terms of medians and gains in medians , but their hazard ratios were significantly correlated . The protective effects of treatment were greater for overall survival than for progression-free survival . Meaning Progression-free survival can not adequately capture the benefit of PD-1 inhibitors ; thus , overall survival should remain the gold st and ard end point for trials of PD-1 inhibitors 
    Output:
    
There were statistically significant and clinical ly relevant benefits in patients treated with bevacizumab versus no bevacizumab mainly around OS , PFS , PPS and the metastasectomy rate , but not for the disease control rates .
However , there was an increase in treatment-related toxicities and concerns with the heterogeneity of the studies .
Conclusion The results pointed to an advantage in favor of bevacizumab for OS , PFS , PPS , and metastasectomy .
Although this advantage may be considered clinical ly modest , bevacizumab represents a hope for increased survival and a chance of metastasectomy for patients with mCRC .