Table 5. Chinese Herbal Medicine for Reducing Chemotherapy Related Toxicity: Overview of Meta-Analyses Results.
| First author and year of publication | Cancer cite | Comparison^ | Outcome assessment method# | No. of studies (No. of patients) | Pooled results (95%CI)¶ | Heterogeneity I2 (%) | Quality of evidence |
|---|---|---|---|---|---|---|---|
| Leucopenia | |||||||
| Wu,2009a | NSCLC | Aidi injection + NP vs. NP | Grade II–IV | 13 (1000) | RR: 0.59[0.52, 0.67] | NR | Low |
| Dong,2010b | NSCLC | SFI+ platinum containing chemotherapy vs. platinum containing chemotherapy | Grade III–IV | 20(1643) | RR: 0.37[0.29, 0.47] | 0.0 | Moderate |
| Li, 2013 | NSCLC | CHM+ chemotherapy vs. chemotherapy | Grade III–IV | 9(666) | RR: 0.36[0.26, 0.52] | 0.0 | Moderate |
| CHM+ chemotherapy vs. chemotherapy | Grade I–IV | 8(603) | RR: 0.75[0.67, 0.84] | 20.0, | Moderate | ||
| Xu, 2014 | NSCLC | KLT+ chemotherapy vs. chemotherapy | Grade III–IV | 10(982) | OR: 0.54[0.38, 0.77] | 52.0* | Moderate |
| Liu,2009 | CRC | CHM+ chemotherapy vs. chemotherapy | Grade I | 6(334) | RR: 0.50[0.31, 0.80] | 7.0 | Moderate |
| CHM+ chemotherapy vs. chemotherapy | Grade II | 6(334) | RR: 0.37[0.21, 0.66] | 0.0 | Low | ||
| CHM+ chemotherapy vs. chemotherapy | Grade III | 5(281) | RR: 0.47[0.19, 1.19] | 0.0 | Low | ||
| CHM+ chemotherapy vs. chemotherapy | Grade IV | 2(129) | RR: 0.13[0.02, 1.05] | 0.0 | Low | ||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Neutropenia grade III–IV | 10(692) | RR: 0.33[0.18, 0.60] | 0.0 | Low |
| Shi, 2012 | Gastric cancer | CHM+ chemotherapy vs. chemotherapy | Grade II–IV | 7(353) | OR: 0.26[0.18, 0.37] | 35.0 | Moderate |
| Dong, 2010a | Various | Astragalus injection + chemotherapy vs. chemotherapy | Grade I–IV | 9(927) | RR: 0.84 [0.79, 0.88] | 77.3* | Low |
| Fu, 2010 | Various | CHM+ chemotherapy vs. chemotherapy | Grade I–IV | 11(2169) | OR: 0.40 [0.23, 0.68] | 55.0* | Moderate |
| Nausea and vomiting | |||||||
| Wu, 2009a | NSCLC | Aidi injection + NP vs. NP | Grade II–IV | 10 (781) | RR: 0.52[0.43, 0.62] | NR | Low |
| Dong, 2010b | NSCLC | SFI+ platinum containing chemotherapy vs. platinum containing chemotherapy | Grade III–IV | 14(1031) | RR: 0.32[0.22, 0.47] | 0.0 | Moderate |
| Li, 2013 | NSCLC | CHM+ chemotherapy vs. chemotherapy | Grade III–IV | 4(295) | RR: 0.24[0.12, 0.50] | 0.0 | Moderate |
| Xu, 2014 | NSCLC | KLT+ chemotherapy vs. chemotherapy | Grade III–IV | 10(982) | OR: 0.54[0.38, 0.77] | 52.0* | Moderate |
| Li, 2012b | Liver cancer | CHM+TACE vs. TACE alone or TACE+ conventional care | Grade I–IV | 11(816) | RR: 0.79[0.69, 0.91] | 48.0* | Moderate |
| Cheung, 2013 | Liver cancer | CHM+TACE vs. TACE | Grade I–IV | 9(581) | RR: 0.86 [0.76, 0.96] | 40.0 | Moderate |
| Liu, 2009 | CRC | CHM+ chemotherapy vs. chemotherapy | Grade I | 6(334) | RR: 0.85 [0.60, 1.20] | 0.0 | Moderate |
| CHM+ chemotherapy vs. chemotherapy | Grade II | 6(334) | RR: 0.51 [0.31, 0.84] | 0.0 | Moderate | ||
| CHM+ chemotherapy vs. chemotherapy | Grade III | 6(334) | RR: 0.49 [0.23, 1.05] | 0.0 | Moderate | ||
| CHM+ chemotherapy vs. chemotherapy | Grade IV | 1(61) | RR: 0.11 [0.01, 1.92] | NA | Very low | ||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Grade III–IV | 9(633) | RR: 0.34[0.18, 0.66] | 0.0 | Moderate |
| Shi, 2012 | Gastric cancer | CHM+ chemotherapy vs. chemotherapy | Grade II–IV | 5(279) | OR: 0.48[0.34, 0.66] | 0.0 | Moderate |
| Thrombocytopenia | |||||||
| Dong, 2010b | NSCLC | SFI+ platinum containing chemotherapy vs. platinum containing chemotherapy | Grade III–IV | 18(1335) | RR: 0.33[0.21, 0.52] | 0.0 | Moderate |
| Li, 2013 | NSCLC | CHM+ chemotherapy vs. chemotherapy | Grade III–IV | 6(557) | RR: 0.34[0.17, 0.68] | 0.0 | Moderate |
| CHM+ chemotherapy vs. chemotherapy | Grade I–IV | 6(494) | RR: 0.43[0.31, 0.60] | 0.0 | Moderate | ||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Grade III–IV | 1(42) | RR: 1.00[0.07, 14.95] | NA | Moderate |
| Shi, 2012 | Gastric cancer | CHM+ chemotherapy vs. chemotherapy | Grade II–IV | 4(225) | OR: 0.35[0.14, 0.86] | 0.0 | Moderate |
| Dong, 2010a | Various | Astragalus + chemotherapy vs. chemotherapy | Grade I–IV | 8(829) | RR: 0.69 [0.56, 0.85] | 83.5* | Moderate |
| Fu, 2010 | Various | CHM+ chemotherapy vs. chemotherapy | Grade I–IV | 7(1162) | OR: 0.41 [0.27, 0.62] | 8.9 | Moderate |
| Anemia | |||||||
| Dong, 2010b | NSCLC | SFI+ platinum containing chemotherapy vs. platinum containing chemotherapy | Grade III–IV | 15(1161) | RR: 0.44[0.30, 0.66] | 0.0 | Moderate |
| Li, 2013 | NSCLC | CHM+ chemotherapy vs. chemotherapy | Grade I–IV | 6(553) | RR: 0.64[0.51, 0.80] | 25.0 | Moderate |
| CHM+ chemotherapy vs. chemotherapy | Grade III–IV | 6(536) | RR: 0.58[0.26, 1.29] | 0.0 | Moderate | ||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Grade III–IV | 3(220) | RR: 0.30[0.05, 1.89] | 0.0 | Low |
| Shi, 2012 | Gastric cancer | CHM+ chemotherapy vs. chemotherapy | Grade II–IV | 4(207) | OR: 0.38[0.25, 0.58] | 43.0 | Moderate |
| Dong, 2010a | Various | Astragalus+ chemotherapy vs. chemotherapy | Grade I–IV | 4(371) | RR: 0.42 [0.27, 0.65] | 33.1 | Moderate |
| Neurotoxicity | |||||||
| Liu,2009 | CRC | CHM+ chemotherapy vs. chemotherapy | Grade I | 5(273) | RR: 0.84 [0.57, 1.24] | 0.0 | Low |
| CHM+ chemotherapy vs. chemotherapy | Grade II | 5(273) | RR: 0.73 [0.45, 1.19] | 0.0 | Low | ||
| CHM+ chemotherapy vs. chemotherapy | Grade III | 5(273) | RR: 0.40 [0.13, 1.25] | 0.0 | Low | ||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Grade III–IV | 7(529) | RR: 0.39[0.15, 1.00] | 0.0 | Low |
| Other chemotherapy related toxicity | |||||||
| Chen, 2014 | CRC | CHM+FOLFOX4 vs. FOLFOX4 | Diarrhea grade III–IV | 5(448) | RR: 0.39[0.11, 1.42] | 0.0 | Low |
| CHM+FOLFOX4 vs. FOLFOX4 | Stomatitis grade III–IV | 2(210) | RR: 0.43[0.08, 2.31] | 0.0 | Low | ||
Keys: CHM, Chinese herbal medicine; CI confidence interval; CRC, colorectal cancer; FOLFOX, the FOLFOX regimen refers to 5–Fluorouracil + Leucovorin combined with Oxaliplatin; KLT, Kanglaite injection; NA, not applicable; NSCLC, non-small lung cell cancer; NP, Cisplatin + Vinorelbine; NR, not reported; OR, odds ratio; RR, relative risk; SFI, Shenqi Fuzheng injection; TACE, Transcatheter arterial chemoembolization.
#All chemotherapy toxicities were measured with the World Health Organization toxicity criteria;
*p < 0.05 for the heterogeneity test;
^CHM denotes the inclusion of all types of Chinese herbal medicines. The use of generic terms “chemotherapy” or “radiotherapy” denote that the specific treatments used were not described in the original meta-analyses publications.
¶Effects on dichotomous data were summarized with risk ratio (RR) or odds ratio (OR) to measure the risk of experiencing certain outcome in the treatment group as compared to the control group.