Integrative Herbal Medicine for Chemotherapy-Induced Peripheral Neuropathy and Hand-Foot Syndrome in Colorectal Cancer: A Systematic Review and Meta-Analysis

Abstract

Objectives: To assess the clinical evidence for integrative herbal medicine therapy in the management of chemotherapyinduced peripheral neuropathy (CIPN) and hand-foot syndrome (HFS) resulting from treatments for colorectal cancer (CRC). Design: Randomized controlled trials (RCTs) were identified from major English and Chinese databases. Participants had been diagnosed with CRC by pathology and had received or were undergoing chemotherapy. Interventions included herbal medicines administered orally or topically. Controls were placebo, supportive care or conventional chemotherapy for CRC. Methods followed the Cochrane handbook. Meta-analyses were grouped by study design, outcome measure, severity, and chemotherapy. Random-effects models with 95% confidence intervals were used. Heterogeneity was assessed as I 2 . Results: Sixty-three RCTs (4286 participants) were included. Five used a placebo in the control groups. Fifty-eight studies tested oral herbal medicine, and 5 tested topical herbal medicine. Data were available for CIPN (60 studies) and HFS (12 studies). Fifty-seven studies combined orally administered herbal medicine with chemotherapy compared with the same chemotherapy. For CIPN, 33 studies used World Health Organization (WHO) criteria, 7 used Levi's criteria, and 10 used the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). These were analyzed separately. For grades III + IV CIPN, there was a significant reduction in the integrative groups for WHO (relative risk [RR] 0.42 [0.23, 0.77], I 2 = 0%) and Levi's (RR 0.28 [0.11, 0.69], I 2 = 0%) but not NCI-CTCAE (RR 0.65 [0.37, 1.13], I 2 = 26.4%). Hand and foot baths showed no differences for Levi's grades III + IV CIPN but a significant reduction in all grades (RR 0.69 [0.50, 0.95], I 2 = 68.8%). For HFS (all grades) there was a significant reduction in the integrative groups for WHO (RR 0.62 [0.41, 0.96], I 2 = 22%) but not for NCI-CTCAE (RR 0.93 [0.55, 1.55], I 2 = 75.7%). Sensitivity analyses explored sources of heterogeneity. Conclusions: Integrative herbal therapy appeared to reduce CIPN and HFS in people receiving chemotherapy for CRC. However, the strength of the evidence was limited by lack of blinding in most studies, potential for bias, and relatively short study durations.

Chemotherapy-induced peripheral neuropathy—part 2: focus on the prevention of oxaliplatin-induced neurotoxicity

“…The efficacy of complementary therapies in the prevention and treatment of CIPN has also been a subject of research. Herbal medicinal therapies (e.g., Acorus calamus, Cannabis species, Matricaria chamomilla, Ginkgo biloba, Curcuma longa, Camellia sinensis) counteract phenomena underlying CIPN, i.e., they reduce oxidative stress and attenuate inflammation in animals [163], but their utility for CIPN prevention requires further investigation to confirm their efficacy and safety [164][165][166][167].…”

Effects of Nonpharmacological Interventions in Chemotherapy-Induced Peripheral Neuropathy: An Overview of Systematic Reviews and Meta-Analyses

“… 38 Kuriyama and Endo 38 found that oral goshajinkigan decreased the incidence of DEB-NTC grade ≥3 CIPN (RR = 0.42 [0.25-0.71]). Liu et al 39 reported that oral herbal medicine was superior to no intervention in grade ≥3 CIPN with WHO (RR = 0.42 [0.23-0.77]) and Levi scale (RR = 0.28 [0.11-0.69]). Four other studies were dedicated to oxaliplatin regimens.…”

“…23,43 Both studies reported a reduction in the neurotoxicity incidence by the herbal medicine group (Yang et al 43 ). It should be noted that substantial heterogeneities were found in the meta-analyses from Liu et al's study, 39 but in the sensitivity analyses, the pooled result of studies remained significant without heterogeneity (I 2 = 0%) after omitting 4 studies. [49][50][51][52] Incidence of Grade ≥2 CIPN/OIPN.…”

Traditional Chinese Medicine Could Play an Important Role in Integrative Palliative Care in China

“…42 As an adjuvant therapy, TCM can be used to treat other symptoms, such as dyspnea, cancer-related fatigue, taste changes, and neuropathy. [43][44][45][46][47][48][49][50][51][52] Thus, it is believed that combining TCM and IPC would produce more satisfying results for patients. However, it should be noted that toxicity and side effects of Chinese herbs and adverse reactions to acupuncture have been reported.…”