Efficacy of Herbal Medicines Intervention for Colorectal Cancer Patients With Chemotherapy-Induced Gastrointestinal Toxicity — a Systematic Review and Meta-Analysis

Abstract

Purpose: Chemotherapy-induced gastrointestinal (CIGI) toxicity affects the quality of life of patients with colorectal cancer (CRC) and the clinical application of treatment drugs. This review aims to evaluate the efficacy of traditional herbal medicines (HMs) in alleviating symptoms of CIGI toxicity (including nausea and vomiting, anorexia, diarrhea, constipation, oral mucositis, abdominal pain, and abdominal distension), and to explore further individual herb or herbal combinations in alleviating the CIGI toxicity.Methods: Nine electronic databases were screened from 2010 to 2020. Twenty-two randomized controlled trials with a total of 1,995 patients evaluating the complementary efficacy of HMs with chemotherapy compared with chemotherapy-alone were included. Further, sensitivity analyses of orally administered multi-ingredient HM interventions were explored based on the composition of HM interventions.Results: The meta-analysis showed that HM treatment combined with chemotherapy significantly alleviated the overall CIGI toxicity (RR = 0.78 [0.72, 0.84], p < 0.001, I2 = 44%), nausea and vomiting (RR = 0.74 [0.66, 0.82], p < 0.001, I2 = 35%), diarrhea (P = 0.02, RR = 0.64, 95% CI = 0.44–0.93, I2 = 50%), oral mucositis (RR = 0.65 [0.48, 0.88], P = 0.005, I2 = 24%), and abdominal distension (RR = 0.36 [0.18, 0.73], P = 0.004, I2 = 0%). However, no statistically significant effects of HMs were shown in studies with a double-blind design for CIGI toxicity. Based on the ingredients of the HMs, further sensitivity analyses identified five herbs [Glycyrrhiza uralensis Fisch., Atractylodes macrocephala Koidz., Astragalus membranaceus (Fisch.) Bge., Codonopsis pilosula (Franch.) Nannf., and the pericarp of Citrus reticulata Blanco.] that were associated with significant reductions in CIGI toxicity.Conclusion: A statistically significant effect of HMs combined with chemotherapy on alleviating the overall CIGI toxicity, nausea and vomiting, diarrhea, oral mucositis, or abdominal distension is only shown in studies without a double-blind design. Further well-designed, double-blinded, large-scaled randomized controlled trials (RCTs) are warranted to comprehensively evaluate the treatment efficacy. Further clinical research that includes the five herbs with chemotherapy for patients, the safety of the combinations of these herbs, and the potential synergistic effects of these combinations of herbs should be conducted.

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

“…( 53 ) and Chen Y et al. ( 54 ). All significant RR results were shown in Tables 6A and 6B , and only the RRs with low heterogeneity (I 2 < 30%) that were not greater than the total pooled RR were shown in the text.…”

“…SD, standard deviation; KPS, Karnofsky Performance Status; TMPs, traditional medicine preparations; E/C, experimental group (TMPs combined with chemotherapy)/control group (chemotherapy alone); M/F, male/female; BSA, body surface area; O, outcome; O1, tumor response; O2, quality of life (QOL); O3, the cancer biomarkers; O4, adverse drug reactions (ADRs).analysis was conducted based on the specific ingredients of TMPs from each study listed in Table1according to the method described in Chen MH, et al(53) and Chen Y et al(54). All significant RR results were shown in Tables6A and 6B, and only the RRs with low heterogeneity (I 2 < 30%) that were not greater than the total pooled RR were shown in the text.…”

Ginseng-containing traditional medicine preparations in combination with fluoropyrimidine-based chemotherapy for advanced gastric cancer: A systematic review and meta-analysis

“…As previous described [ 49 , 50 ], a subgroup analysis was conducted on particular components of ginseng-containing preparations from each trial, as listed in Table 1 , to determine the combination of ginseng and other herbs with FBC with the most contribution to AGC treatment. Tables 5 and 6 only include RRs that had a low heterogeneity ( I 2 < 30%) and were less than the overall pooled RR.…”

Management of pain in patients with bone metastases

“…For these reasons, it has gained traction as a treatment option for patients with CIBP. Studies have shown that astragalus, psoralen, scutellaria barbata, atractylodes macrocephala, and corydalis can significantly inhibit CIBP in patients with cancer ( 82 – 85 ). Insect drugs, such as scorpion and Huchansu have also been shown to be effective for the management of CIBP ( 86 – 88 ).…”