Clinical Efficacy and Safety of Traditional Medicine Preparations Combined With Chemotherapy for Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis

Abstract

BackgroundTraditional medicine preparations (TMPs) combined with chemotherapy is widely used for patients with advanced pancreatic cancer (APC); however, its efficacy and safety are still unclear. The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of TMPs combined with chemotherapy for the treatment of APC.MethodsA systematic search of eight electronic databases for randomized controlled trials (RCTs) was conducted from inception to October 15, 2021. Tumor response was identified as primary outcome, whereas quality of life (QoL), cancer biomarkers, and adverse drug reactions (ADRs) were identified as secondary outcomes. Quality of the evidence for each outcome was evaluated by GRADE profiler.ResultsIn total, 31 RCTs involving 1,989 individuals were included. This meta-analysis showed that TMPs combined with chemotherapy significantly improved the objective response rate (ORR) (RR=1.64, 95% CI [1.43 to 1.88], p <0.00001), disease control rate (DCR) (RR=1.29, 95% CI [1.21 to 1.38], p <0.00001), and QoL (continuous data: SMD=0.81, 95% CI [0.44 to 1.18], p <0.0001, dichotomous data: RR=1.44, 95% CI [1.22 to 1.70], p<0.0001), compared to those with chemotherapy alone. In addition, the combined treatment group also had lower levels of CA19-9 (SMD=-0.46, 95% CI [-0.90 to -0.02], p=0.04) and CEA (SMD=-0.55, 95% CI [-0.93 to -0.17], p=0.004). Moreover, TMPs reduced the ADRs during chemotherapy.ConclusionThis systematic review suggests that TMPs combined with chemotherapy might be a potential option to enhance therapeutic effects and reduce ADRs during the treatment of APC. However, more high-quality randomized controlled trials with more participants are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209825, identifier PROSPERO Number: CRD42021264938.

Efficacy and safety of traditional Chinese medicine for the treatment of pancreatic cancer: An overview of systematic reviews and meta-analyses

“…However, a list of the excluded literature was not included in the dissertation. As for literature retrieval, only one study ( Deng, 2018 ) adopted a comprehensive and systematic retrieval method, and five studies ( Wang, 2017 ; Deng, 2018 ; Cheng and Cao, 2020 ; Ding et al, 2020 ; Hu et al, 2022 ) had the literature screened independently and reproducibly by two researchers. To better understand and compare the results, the specific characteristics of the RCTs should be described in detail as denoted by the PICO principles.…”

“…To better understand and compare the results, the specific characteristics of the RCTs should be described in detail as denoted by the PICO principles. However, only three studies ( Liu et al, 2019 ; Ding et al, 2020 ; Hu et al, 2022 ) presented comprehensive information for each included study, while the descriptions in the other SRs/MAs did not meet the requirements to varying degrees.…”

“…Six studies combined the effect size of the clinical efficacy rate ( Lu et al, 2014 ; Wang, 2017 ; Xie et al, 2017 ; Deng, 2018 ; Cheng and Cao, 2020 ; Ding et al, 2020 ) and observed significant differences between the experimental and control groups. Two studies ( Li et al, 2015 ; Hu et al, 2022 ) reported the objective response rate as an outcome indicator. Two studies ( Wang, 2017 ; Liu et al, 2019 ) reported a complete remission rate.…”

“…Five studies ( Li et al, 2015 ; Liu et al, 2019 ; Cheng and Cao, 2020 ; Ding et al, 2020 ; Hu et al, 2022 ) reported efficacy differences in QOL improvement. Li et al (2015) and Hu et al (2022) compared the pooled analysis of QOL results using the expression of RR and MD.…”

“…Five studies ( Li et al, 2015 ; Liu et al, 2019 ; Cheng and Cao, 2020 ; Ding et al, 2020 ; Hu et al, 2022 ) reported efficacy differences in QOL improvement. Li et al (2015) and Hu et al (2022) compared the pooled analysis of QOL results using the expression of RR and MD. Li et al (2015) demonstrated the potential benefit of TCM combined with Western medicine on QOL improvement compared to Western medicine, but the difference only existed when the RR was pooled for the measurement data, whereas the difference was not statistically significant when the MD effect size was pooled for the count data.…”