Kanglaite Injection Combined with Chemotherapy versus Chemotherapy Alone for the Improvement of Clinical Efficacy and Immune Function in Patients with Advanced Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract

Recent advances have shown that immune checkpoint inhibitors are emerging as promising therapeutic targets to improve the quality of life in cancer patients. This meta-analysis was conducted to evaluate the influence of Kanglaite injection (KLTi) combined with chemotherapy versus chemotherapy alone on clinical efficacy, immune function, and safety for the treatment of advanced non-small-cell lung cancer (NSCLC). Several electronic databases, including PubMed, Web of Science, Wan-Fang, VMIS, EMBASE, Cochrane Library, CNKI, CBM, and MEDLINE, as well as grey literatures, were comprehensively searched from January 2000 to November 2019. Randomized controlled trials (RCTs) reporting outcomes of clinical efficacy and immune function were collected according to their inclusion and exclusion criteria. Cochrane Reviewers' Handbook 5.2 was applied to assess the risk of bias of included trials. STATA 13.0 and Review Manager 5.3 software were used for meta-analysis. Twenty-five RCTs comprising 2151 patients meeting the inclusion criteria were identified. Meta-analysis showed that compared with chemotherapy alone, KLTi plus the same chemotherapy significantly improved clinical efficacy, including complete response, partial response, stable disease, and progressive disease, as well as immune function, including CD³⁺, CD⁴⁺, CD⁸⁺, and CD⁴⁺/CD⁸⁺. There was a significant reduction in nausea and vomiting, thrombocytopenia, and leukopenia in combination treatments. However, the outcomes were limited because of the low quality and small sample size of the included studies. In conclusion, this work might provide beneficial evidence of KLTi combined with chemotherapy for improving clinical efficacy and immune function, as well as reducing the incidence of adverse events in advanced NSCLC patients. KLTi might be a beneficial therapeutic method for the treatment of advanced NSCLC. Due to the quality of the data, more rigorous and well-designed RCTs are needed to confirm these findings.

Figure 1

Research strategy of the current study.

Figure 2

PRISMA flow diagram of study inclusion for this systematic review and meta-analysis.

Figure 3

Quality assessment was performed using Review Manager 5.3 according to the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.2. The red square indicates a high risk of bias. The green square indicates a low risk of bias, and the blank square indicates an unclear risk of bias.

Figure 4

Forest plot of clinical efficacy in advanced NSCLC patients treated with KLTi combined with chemotherapy and chemotherapy alone. (a) CR; (b) PR; (c) SD; and (d) PD.

Figure 5

Forest plot of KLTi plus chemotherapy versus chemotherapy alone on (a) short-term clinical effective rate and (b) disease control rate.

Figure 6

Forest plot of KPS improvement in patients treated with KLTi combined with chemotherapy and chemotherapy alone.

Figure 7

Subgroup analysis of nausea and vomiting in patients with advanced NSCLC treated with KLTi combined with chemotherapy and chemotherapy alone.

Figure 8

Subgroup analysis of thrombocytopenia in patients with advanced NSCLC treated with KLTi combined with chemotherapy and chemotherapy alone.

Figure 9

Subgroup analysis of leukopenia in patients with advanced NSCLC treated with KLTi combined with chemotherapy and chemotherapy alone.

Figure 10

Funnel plot for publication bias of (a) the clinical efficacy and (b) disease control rate.