Network meta-analysis of Chinese herb injections combined with FOLFOX chemotherapy in the treatment of advanced colorectal cancer

Abstract

Summary What is known and Objective Research has indicated that some Chinese herb injections (CHIs) might be beneficial in combination with chemotherapy, including remedies that might be used as effective chemosensitizers and radiosensitizers, or as palliative therapy. Here, we carried out a network meta‐analysis to assess the clinical efficacy and safety of CHIs combined with oxaliplatin, 5‐fluorouracil and leucovorin (FOLFOX) for advanced colorectal cancer (CRC). Methods PubMed, EMBASE.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM), Wanfang Database and Chinese Journal Full‐text Database were searched from inception to 31 December 2014, to identify relevant randomized controlled trails (RCTs). The risk of bias in included RCTs was evaluated according to the Cochrane Handbook version 5.1.0. Standard pairwise meta‐analysis and Bayesian network meta‐analysis were performed to compare the efficacy and safety of different CHIs combined with FOLFOX. Data were analysed using STATA 12.0 and WinBUGS1.4 software. Results and discussion We identified 63 eligible studies (with 4837 patients in total), involving 9 CHIs. Pairwise meta‐analysis showed that compared with FOLFOX alone, combinations with Aidi injection and compound matrine injection could significantly improve the overall response rate and quality of life and reduce the incidence of nausea and vomiting (III‐IV), diarrhoea (III–IV), thrombocytopenia (III–IV), leukopenia (III–IV) and peripheral neurotoxicity (III–IV). According to results of indirect comparison, there were no statistically significant differences for most of comparison groups. Aidi+FOLFOX, shenqifuzheng+FOLFOX and compound matrine+FOLFOX had the greatest probability of being the best treatment in clinical efficacy and safety, considering the small sample size. What is new and Conclusions Most of the included studies were of low quality, and there was a scarcity of eligible trials and numbers of participants. Based on currently limited evidence, aidi, shenqifuzheng and compound matrine were superior to other CHIs in patients receiving FOLFOX chemotherapy for advanced CRC. More studies are required to confirm the efficacy of CHIs in combination with FOLFOX for advanced CRC.

Natural Product Interventions for Chemotherapy and Radiotherapy-Induced Side Effects

“…Neurotoxicity is a frequent adverse effect of cancer chemotherapy and radiotherapy, and causes excruciating pain to cancer patients. A network meta-analysis shows that Ai-Di, Shen-Qi-Fu-Zheng, and Matrine injections approved by the Food and Drug Administration of China, improve the overall response rate and quality of life, and reduce the incidence of peripheral neurotoxicity (III-IV) for advanced colorectal cancer treated with oxaliplatin, 5-fluorouracil, and leucovorin (Ge et al, 2016 ). Traditional Japanese medicine Goshajinkigan (TJ107) is used to alleviate neuropathy and general pain.…”

Recent Advances in Herbal Medicines for Digestive System Malignancies

“…Aidi injection (CFDA approval number, Z52020236) is an anti-tumor Chinese medicine from the spotted jellyfish, A. membranaceus , Acanthopanax, and ginseng (Xiao et al, 2017 ). Aidi injections can reportedly alleviate side effects of chemotherapeutics and exert an adjuvant effect on the comprehensive treatment of DSM (Wang T. et al, 2014 ; Ge et al, 2016 ). In a meta-analysis of 32 RCTs by Wang et al, Aidi injections combined with chemotherapeutics improved the effective rate of chemotherapeutics for gastric cancer and the patient's quality of life, and decreased incidences of side effects such as nausea and vomiting, diarrhea, leukopenia III–IV, and thrombocytopenia III–IV (Jiancheng et al, 2015 ).…”

“…Because of its potential for preventing and treating cancer, TCM has received wide attention from around the world, including Western countries. Many studies found that TCM combined with radiotherapy or chemotherapy for malignant tumors could significantly reduce the incidence of adverse reactions to radiotherapy or chemotherapy and improve cellular immunity and quality of life for patients (Qi et al, 2010 ; Ge et al, 2016 ; Liu et al, 2016a , b ). Even some TCM preparations have a synergistic effect on chemotherapy, which can both prolong patient survival and reduce tumor recurrence and metastasis (Tian et al, 2012a ; Pandey et al, 2015 ).…”

Polymorphisms in DNA repair pathway genes and&nbsp;<em>ABCG2</em>&nbsp;gene in advanced colorectal cancer: correlation with tumor characteristics and clinical outcome in oxaliplatin-based chemotherapy

“…Although it has become a standard regimen for CRC both as adjuvant therapy and as treatment for metastatic cancer, the response to oxaliplatin-based chemotherapy still varied wildly among individuals in clinical practice. The reported overall response rate was 40% in advanced CRC 3. Studies in human CRC cell lines confirmed that multiple factors are involved in the oxaliplatin resistance and clinical prognosis including decreased drug accumulation and enhanced capacity to repair and tolerate DNA damage 4,5.…”