Meta-Analysis of 5-Fluorouracil-Based Chemotherapy Combined With Traditional Chinese Medicines for Colorectal Cancer Treatment

Abstract

This meta-analysis evaluates the clinical evidence for the addition of traditional Chinese medicines (TCMs) to 5-fluorouracil (5-FU)-based regimens for colorectal cancer (CRC) in terms of tumor response rate (TRR). Five electronic databases were searched for randomized controlled trials of 5-FU-based chemotherapy combined with TCMs compared to the same 5-FU-based regimen. Forty-five randomized controlled trials were involved in this study, and all the data were analyzed by Stata software (version 14.0). Our results suggested that the TRR of the group with TCMs combined with 5-FU-based regimens was higher than that in the group with 5-FU regimens alone (risk ratio [RR] 1.36 [1.25-1.49], I² = 0%). Furthermore, both nonoral administration (RR 1.51 [1.29-1.76], I² = 0%) and oral administration (RR 1.31 [1.18-1.45], I² = 0%) of TCMs showed benefits to the CRC treatment. Further sensitivity analysis of specific plant-based TCMs found that fuling, sheshecao, banzhilian, eshu, baizhu, huangqi, yiyiren, and dangshen had significantly higher contributions to the results of the risk ratio. Therefore, TCMs may have the potential to improve the efficacy of 5-FU-based chemotherapy for CRC.

Keywords: 5-fluorouracil; colorectal cancer; meta-analysis; traditional Chinese medicine.

Figure 1.

Flow diagram of the search and selection process of randomized controlled trials of 5-FU regimens combined with TCM for CRC.

Figure 2.

Forest plot of meta-analysis of tumor response rate of TCM plus 5-FU-based regimens versus 5-FU-based regimens alone.