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. 2022 Aug 25:13:977708.
doi: 10.3389/fphar.2022.977708. eCollection 2022.

Chinese herbal medicine combined with oxaliplatin-based chemotherapy for advanced gastric cancer: A systematic review and meta-analysis of contributions of specific medicinal materials to tumor response

Ying Tan  1 , Heping Wang  1 , Bowen Xu  1   2 , Xiaoxiao Zhang  1 , Guanghui Zhu  1   2 , Yuansha Ge  1   2 , Taicheng Lu  1   2 , Ruike Gao  1 , Jie Li  1
Affiliations

Chinese herbal medicine combined with oxaliplatin-based chemotherapy for advanced gastric cancer: A systematic review and meta-analysis of contributions of specific medicinal materials to tumor response

Ying Tan et al. Front Pharmacol. .

Abstract

Introduction: The incidence and mortality of gastric cancer ranks among the highest, and the 5-year survival rate of advanced gastric cancer (AGC) is less than 10%. Currently, chemotherapy is the main treatment for AGC, and oxaliplatin is an important part of the commonly used chemotherapy regimen for AGC. A large number of RCTs have shown that Chinese herbal medicine (CHM) combined with oxaliplatin-based chemotherapy can improve objective response rate (ORR) and disease control rate (DCR), reduce the toxic and side effects of chemotherapy. There is currently a lack of systematic evaluation of the evidence to account for the efficacy and safety of CHM combined with oxaliplatin-based chemotherapy in AGC. Therefore, we carried out this study and conducted the sensitivity analysis on the herbal composition to explore the potential anti-tumor efficacy. Methods: Databases of PubMed, EMBASE, CENTRAL, Web of Science, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the Wanfang database, and the Chinese Scientific Journals Database were searched from their inception to April 2022. RCTs evaluating the efficacy of CHM combined with oxaliplatin-based chemotherapy on AGC were included. Stata 16 was used for data synthesis, RoB 2 for quality evaluation of included RCTs, and GRADE for quality of synthesized evidence. Additional sensitivity analysis was performed to explore the potential anti-tumor effects of single herbs and combination of herbs. Results: Forty trials involving 3,029 participants were included. Most included RCTs were assessed as "Some concerns" of risk of bias. Meta-analyses showed that compare to oxaliplatin-based chemotherapy alone, that CHM combined with oxaliplatin-based chemotherapy could increase the objective response rate (ORR) by 35% [risk ratio (RR) = 1.35, 95% confidence intervals (CI) (1.25, 1.45)], and disease control rate (DCR) by 12% [RR = 1.12, 95% CI (1.08, 1.16)]. Subgroup analysis showed that compare to SOX, FOLFOX, and XELOX regimens alone, CHM plus SOX, CHM plus FOLFOX, and CHM plus XELOX could significantly increase the ORR and DCR. Sensitivity analysis identified seven herbs of Astragalus, Liquorice, Poria, Largehead Atractylodes, Chinese Angelica, Codonopsis, and Tangerine Peel with potentials to improve tumor response of oxaliplatin-based chemotherapy in AGC. Conclusion: Synthesized evidence showed moderate certainty that CHM plus oxaliplatin-based chemotherapy may promote improvement in tumor response in AGC. CHM treatment is safe for AGC. Due to the poor quality of included RCTs and small samplesizes, the quality of synthesized evidence was not high. Specific combinations of herbs appeared to produce higher contributions to ORR than the herb individually. Each of this seven above mentioned herbs has been shown in experimental studies to potentially contribute to the improvement of tumor response. To support this conclusion, these seven herbs are worthy of further clinical research. Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262595], identifier [CRD42022262595].

Keywords: Chinese herbal medicine; advanced gastric cancer; efficacy; meta-analysis; oxaliplatin; synergistic action; tumor response.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer SC declared a shared parent affifiliation with the authors BX, GZ, YG, and TL at the time of review.

Figures

FIGURE 1
FIGURE 1
Flowchart of records screening and selection.
FIGURE 2
FIGURE 2
Summary of risk of bias of included trials.
FIGURE 3
FIGURE 3
Forest plot of ORR.
FIGURE 4
FIGURE 4
Forest plot of DCR.
FIGURE 5
FIGURE 5
Forest plot of incidence of AEs of blood system. Incidence of (A) myelosuppression, (B) leucopenia, (C) anemia, and (D) thrombocytopenia.
FIGURE 6
FIGURE 6
Forest plot of incidence of gastrointestinal reaction. Incidence of (A) gastrointestinal reaction, (B) diarrhea, and (C) nausea and vomiting.
FIGURE 7
FIGURE 7
Forest plot of incidence of hepatorenal toxicity. Incidence of (A) hepatorenal toxicity, (B) hepatotoxicity, and (C) renal toxicity.
FIGURE 8
FIGURE 8
Forest plot of incidence of peripheral neurotoxicity.
FIGURE 9
FIGURE 9
Funnel plot of publication bias.
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