Efficacy and safety of Chinese patent medicine (Jinlong capsule) in the treatment of advanced hepatocellular carcinoma: a meta-analysis

Abstract

Jinlong capsule (JLC), a type of herbal medicine, is considered to be a promising adjuvant therapy for hepatocellular carcinoma (HC). Although an analysis of the published literature has been performed, the exact effects and safety of JLC are yet to be systematically investigated. Therefore, a wide-ranging systematic search of electronic databases to draw conclusions was performed. Data from 29 trials, including 2488 patients with advanced HC, were analyzed. The results indicated that, compared with conventional treatment alone, the combination of conventional treatment and JLC markedly improved overall patient response (odds ratio (OR) 2.06 [95% confidence interval (CI) 1.71-2.49]; P<0.00001), disease control rate (DCR) (OR 2.17 [95% CI 1.74-2.71]; P<0.00001) and quality of life (QoL) (OR 2.71 [95% CI 2.05-3.58]; P<0.00001), and significantly prolonged 6- (P=0.01), 12- (P<0.00001), 24- (P=0.001) and 36-month (P<0.0001) overall survival (OS) rates. The immune function of patients was also significantly enhanced after combined conventional therapy and JLC treatment, indicated by clearly increased percentages of CD3+ (P<0.0001), CD4+ (P<0.00001) and natural killer (NK) cells (P=0.0003), and CD4+/CD8+ ratio (P<0.00001). The incidence of leukopenia (P<0.00001), hepatotoxicity (P=0.005), and myelosuppression (P=0.0007) was lower in HC patients injected with JLC, whereas other adverse events did not differ significantly between the two groups (P>0.05). In summary, results of this meta-analysis suggest that the combination of conventional treatment and JLC is more effective for the treatment of HC than conventional treatment alone.

Keywords: Jinlong Capsule; conventional treatment; hepatocellular carcinoma; meta-analysis; traditional Chinese medicine.

Figure 1. Study selection process for the meta-analysis

Figure 2. Forest plot of the comparison of ORR between the experimental and control groups

Control group, conventional treatment alone group; Experimental group, conventional treatment and JLC combined group. The fixed-effects meta-analysis model (Mantel–Haenszel method) was used.

Figure 3. Forest plot of the comparison of DCR between the experimental and control groups

Control group, conventional treatment alone group; Experimental group, conventional treatment and JLC combined group. The fixed-effects meta-analysis model (Mantel–Haenszel method) was used.

Figure 4. Comparisons of OS between experimental and control group

Forest plot of the comparison of 6- (A), 12- (B), 24- (C) and 36-month (D) OS between the experimental and control groups. Control group, conventional treatment alone group; Experimental group, conventional treatment and JLC combined group.

Figure 5. Comparisons of QoL between experimental and control group

Forest plot of the comparison of QIR (A) and KPS (B) between the experimental and control groups. Control group, conventional treatment alone group; Experimental group, conventional treatment and JLC combined group.

Figure 6. Comparisons of immune function between experimental and control group

Forest plot of the comparison of immune function indicators including CD3⁺ (A), CD4⁺ (B), CD8⁺ (C) and NK (D) cells percentage and CD4⁺/CD8⁺ ratio (E) between the experimental and control groups. Control group, conventional treatment alone group; Experimental group, conventional treatment and JLC combined group.