Efficacy and Safety of Xiao Ai Ping Injection Combined with Chemotherapy in Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

Abstract

Xiao Ai Ping injection (XAPI), extracted from the Chinese herbal medicine Marsdenia tenacissima, is widely used in the adjuvant treatment of tumors in China. The present study aimed to evaluate the efficacy and safety of XAPI combined with chemotherapy for treating patients with advanced gastric cancer. Seven databases were searched for relevant studies published up to October 1, 2018, and Review Manager 5.3 software and Stata 12.0 software were used for meta-analysis. Fourteen studies, representing 1097 enrolled patients, were included in our analysis. Compared with chemotherapy alone, combination treatment with XAPI and the XELOX regimen (capecitabine plus oxaliplatin) was found to improve the objective response rate (ORR) [RR=1.36; 95%CI (1.10, 1.70); P=0.006], disease control rate (DCR) [RR=1.15; 95% CI (1.04, 1.28); P=0.010], and Karnofsky Performance Status (KPS) improvement rate [RR=1.51; 95%CI (1.14, 2.00); P=0.004] and to reduce the incidence of leukopenia [RR=0.68; 95%CI (0.55,0.84); P=0.0005], liver damage [RR=0.59; 95% CI (0.37, 0.92); P=0.02], renal impairment [RR=0.39; 95% CI (0.18, 0.85); P=0.02], and hand-foot syndrome [RR=0.56; 95%CI (0.35,0.90); P=0.02]. However, median progression-free survival (PFS), 1-year survival rate, and median overall survival (OS) were not extended by XAPI plus XELOX. Combination treatment with XAPI and the SOX regimen (tegafur plus oxaliplatin) did not improve ORR or DCR, but it did enhance the KPS improvement rate [RR=1.73; 95%CI (1.23,2.43); P=0.002] and reduce the incidence of nausea and vomiting [RR=0.66; 95% CI (0.50, 0.88); P=0.004]. XAPI in combination with the FOLFOX regimen (fluorouracil/calcium folinate/oxaliplatin) enhanced only the KPS improvement rate [RR=1.68; 95%CI (1.18,2.39); P=0.004] and had no significant effect on ORR or DCR or the incidence of adverse events. A single study reported that XAPI combined with the CPT-11 regimen (irinotecan) was superior to chemotherapy alone with respect to DCR and also reduced the incidence of leukopenia, liver damage, and hand-foot syndrome during chemotherapy, while prolonging PFS. Finally, one study reported that XAPI combined with the TP regimen (palitaxel plus cisplatin) improved ORR and KPS improvement rate to a greater extent than TP alone. Although the present review has some limitations, the findings suggest that XAPI combined with chemotherapy may represent a beneficial treatment strategy, particularly the combination of XAPI and XELOX.

Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

“…After removing 26 duplicates, 92 titles and abstracts were further screened. Finally, 20 systematic reviews with MAs ( Xie et al, 2013 ; Yang et al, 2013 ; Li et al, 2014 ; Wang et al, 2014 ; Yao et al, 2014 ; Li et al, 2015 ; Wang et al, 2015 ; Zhang et al, 2017 ; Zhang D. et al, 2018 ; Zhang X. et al, 2018 ; Chen et al, 2018 ; Lee et al, 2018 ; Wu et al, 2018 ; Sun et al, 2019 ; Wu et al, 2019 ; Lu X. et al, 2020 ; Chen et al, 2020 ; Li et al, 2020 ; Wu et al, 2020 ; Cheng et al, 2021 ) in English that focused on CM for gastric cancer were included (no different MA was identified from the reference lists). The selection flow used in this research is displayed in Figure 1 .…”

Chinese Herbal Medicine and Its Regulatory Effects on Tumor Related T Cells

“…A 2019 systematic review and metaanalysis confirms this data. Wu et al (2019) compared data from 14 studies between 2009 and 2018 utilizing a variety of chemotherapy protocols including XELOX (capecitabine and oxaliplatin), SOX (S-1 and oxaluplatin), and others in combination with XIAO AI PING. They concluded that the combination could offer an effective treatment strategy for gastric cancer patients, especially with the XIAO AI PING and XELOX pairing.…”

A Bioinformatics Research on Novel Mechanism of Compound Kushen Injection for Treating Breast Cancer by Network Pharmacology and Molecular Docking Verification

“…Studies have shown that radiotherapy and chemotherapy can increase the risk of myelodysplastic disorder and acute myeloid leukemia in BC patients, which means more pain for patients with poor body function and poor tolerability [2]. Traditional Chinese medicine (TCM), as a traditional medicine for adjuvant treatment of tumors, has the effect of improving the immune function and tumor microenvironment of the patients and reducing the toxicity of radiotherapy and chemotherapy, so as to improve the survival rate [3][4][5][6][7]. It is shown that compound Kushen injection (CKI), as a TCM compound preparation, has a good synergistic antitumor effect by inhibiting tumor cell proliferation and inducing differentiation.…”