Table 1.
Characteristics of the included studies.
| Study | Advanced gastric cancer (AGC) | Interventions | Fellow up | Criteria | Outcome | ||||
|---|---|---|---|---|---|---|---|---|---|
| E/C | M/F | TNM stage | Astragalus-containing TCM | Drug delivery | Platinum-based regimen | ||||
| Yang, J. 2005 (18) | 16/16 | 22/10 | IV | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Poria cocos, Pinellia ternate, Citrus reticulata, Fructus aurantii, Coix seed, Dioscoreae opposita, Hedyotis diffusa, Nightshade, Curcuma zedoary, Rice sprout, Malt, Radix scutellariae, Glycyrrhiza, 300 ml/d, 8w | Orally | 5-Fu: 250 mg/m2, d1–14; OXA: 130 mg/m2, d1, d8, d15, 28d/C; 2 cycles | 8w | WHO, WHO | O1,2,4,5 |
| Gong, L.Y. 2006 (19) | 26/30 | 31/25 | IIIB: 17, IV: 9/IIIB: 19, IV: 11 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d, 21d/C, 4 cycles | Injection | PTX: 135 mg/m2, d1; 5-Fu: 500 mg/m2, d1–5; CF: 100 mg/m2, d1–5; DDP: 30 mg/m2, d1–3, 3w/C, 4 cycles | >12m | RECIST, WHO | O1,2,3,5,6 |
| Chen, P. 2007 (20) | 64/64 | 90/38 | IV | Cidan Capsule: Astragalus, Curcuma zedoary, Brucea javanica, Pleione bulbocodioides, Semen strychni, Nidus vespae, 5.4 g/d, 28d/C, 3 cycles | Orally | OXA: 100 mg, d1, d8; CF: 50 mg, d1–5; 5-Fu: 0.5–0.75 g, d1–5; 4w/C, 3 cycles | 12w | WHO, WHO | O1,2,5 |
| Li, A.M. 2007 (21) | 64/64 | 86/42 | III, IV | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Poria cocos, Radix ophiopogonis, Spatholobus suberctu, Radix salviae miltiorrhizae, Ligustrum lucidum ait, Hedyotis diffusa, 400 ml/d, d1–21, 28d/C, 3 cycles | Orally | DDP: 20 mg/m2, d1–5; LV: 200 mg/m2, d1–5; 5-FU: 500 mg/m2, d1–5; 4w/C, 3 cycles | 12w | WHO, WHO | O1,2,5 |
| Wang, L. 2007 (22) | 15/15 | 23/7 | IIIB, IV | Astragalus-based formulae: Astragalus, Atractylodis macrocephala, Radix pseudostellariae, Noria cocos, Dioscoreae opposita, Pinellia ternate, Citrus reticulata, Coix seed, Galli gigerii endothelium corneum, Hedyotis diffusa, Scutellariae barbatae, Rice sprout, Malt, Glycyrrhiza, 300 ml/d, 8w | Orally | PTX: 135 mg/m2, d1, d8; OXA: 130 mg/m2, d1, d8; 5-Fu: 500 mg/m2, d1–5; 4w/C, 2 cycles | >8w | WHO, WHO | O1,2,4,5 |
| He, Z.Q. 2008 (23) | 65/58 | 68/55 | IV | Delisheng: Astragalus, Red ginseng, Arenobufagin, Cantharides, 40 ml/d, 20 d/C, 4–6 cycles | Injection | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 4–6 cycles | Unknow | RECIST, WHO | O1,2,5,6 |
| Liu, L.H. 2009 (24) | 30/30 | 34/26 | IIIB: 17, IV: 13/IIIB: 14, IV: 16 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d, d1–10, 28d/C, 2 cycles | Injection | PTX: 175 mg/m2, d1; DDP: 20 mg/m2, d1–5; 5-Fu: 600 mg/m2, d1–5; 28d/C, 2 cycles | 8w | WHO, WHO | O1,2,4,5 |
| Liu, X.Q. 2009 (25) | 30/30 | 42/18 | IV | Kangai: Astragalus, Ginseng, Matrine, 60 ml/d, 10d/C, 2 cycles | Injection | CF: 200 mg/m2, d1–2; 5-Fu: 2.0 g/m2,48 h; DOC: 50 mg/m2, d1; DDP: 25 mg/m2, d2–3; 14d/C; 2 cycles | 4w | RECIST, NCI | O1,2,4,5 |
| Zhu, Y. 2010 (26) | 20/20 | 23/17 | III, IV | Astragalus-based formulae: Astragalus, Codonopsis, Angelica sinensis, Paeonia lactiflora, Costusroot, Bupleurum, Coix seed, Notoginseng radix, Fructus aurantii, Rhizoma bletillae, Curcuma zedoary, Glycyrrhiza, Radix platycodi, Fritillary bulb, Crotonis fructus, 400 ml/d, 6w | Orally | OXA: 130 mg/m2, d1; CF: 300 mg, d1–5; 5-Fu: 500 mg, d1–5; 3w/C, 2 cycles | 6w–1y | RECIST, WHO | O1,2,3,4,5 |
| Chen, Q.S. 2011 (27) | 30/30 | 37/23 | III: 17, IV: 13/III: 19, IV: 11 | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Noria cocos, Ninellia ternate, Ganoderma, Agrimonia pilosa, Prunellae spica, Hedyotis diffusa, Glycyrrhiza, 400 ml/d, 21d/C, 2 cycles | Orally | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 21d/C, 2 cycles | 6w–1y | WHO,Un | O1,2,3,4,5,6 |
| Du, C.J. 2011 (28) | 120/120 | 122/118 | IV | Astragalus-based formulae: Astragalus, Atractylodis macrocephala, Poria cocos, Pinellia ternate, Citrus reticulata, Rhizoma polygonati, Glycyrrhiza, Ligustrum lucidum ait, Sanguisorbae radix, Spatholobus suberctu, Donkey-hide glue, Radix actinidiae, 400 ml/d, 21d/C, 2 cycles | Orally | OXA: 100 mg/m2, d1; CF: 200 mg/m2, d1–5; 5-Fu: 500 mg/m2, d1–5; 21d/C, 2 cycles | 6w | RECIST | O1,2 |
| Fan, C.M. 2011 (29) | 23/28 | 33/18 | IIIA: 8, IIIB: 10, IV: 5/IIIA: 10, IIIB: 13, IV:5 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d,10d/C, 4 cycles | Injection | OXA: 85 mg/m2, d1; S-1: 80 mg/m2, d1–14; 21d/C, 4 cycles | >12w | WHO, WHO | O1,2,3,4,5 |
| Hu, F.S. 2011 (30) | 51/48 | 69/30 | IV | Astragalus-based formulae: Astragalus, Codonopsis, Radix pseudostellariae, Atractylodis macrocephala, Poria cocos, Fructus lycii, Ligustrum lucidum ait, Semen cuscutae, Spatholobus suberctu, Paeonia rubra, Curcuma zedoary, Polyphylla, Hedyotis diffusa, Radix actinidiae, 400 ml/d, 21d/C, 3 cycles | Orally | CAP: 1,000 mg/m2, d1–14; OXA: 130 mg/m2, d1; 21d/C, 3 cycles | 9w | WHO, WHO | O1,2,4,5,6 |
| Ren, Y.Z. 2012 (31) | 33/32 | 30/35 | IV | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d, 14d/C, 3 cycles | Injection | OXA: 85 mg/m2, d1; CF: 300 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 3 cycles | 6w | WHO | O1,2 |
| Wang, J.R. 2012 (32) | 26/24 | 32/18 | III: 15, IV: 11/III: 14, IV: 10 | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d, 14d/C, 2 cycles | Injection | DOC: 75 mg/m2, d1; DDP: 20 mg/m2, d1–5; 5-Fu:750 mg/m2, d1–5; 28d/C, 2 cycles | 8w-24w | RECIST, WHO | O1,2,4,5 |
| Li, H.Y. 2013 (33) | 35/35 | 35/35 | III: 14, IV: 21/III: 16, IV: 19 | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d,14d/C, 4 cycles | Injection | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 4 cycles | 8w | WHO,Un | O1,2,5 |
| Tan, G. 2013 (34) | 26/22 | 26/22 | IV | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Poria cocos, Dioscoreae opposita, Citrus reticulata, Amomum, Galli gigerii endothelium corneum, Aflatoxin, Salviae miltiorrhizae, Cowherb seed, Hedyotis diffusa, Ganoderma, Scutellariae barbatae, 400 ml/d, 28d/C, 2 cycles | Orally | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d–5; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 4 cycles | 8w | WHO, WHO |
O1,2,4 |
| Yin, L.L. 2013 (35) | 26/27 | 27/26 | III: 16, IV: 10/III: 14, IV: 13 | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d, 14d/C, 2 cycles | Injection | S-1: 120 mg/d, d1–21; DDP: 20 mg/m2, d1–5; 4w/C, 2 cycles | 8w | WHO, NCI | O1,2,5,6 |
| Fei, Y.H. 2014 (36) | 40/40 | 54/26 | III: 21, IV: 19/III: 18, IV: 22 | Astragalus-based formulae: Astragalus, Codonopsis, Ganoderma, Atractylodis macrocephala, Poria cocos, Radix ophiopogonis, Polyporus umbellatus, Pinellia ternate, Fructus aurantii, Coix seed, Hedyotis diffusa, Curcuma, Bambusae caulis in taenias, 400 ml/d, 3w | Orally | DOC: 40 mg/m2, d1, d8; DDP: 15 mg/m2, d1–5; 5-Fu, 600 mg/m2, d1–5; 28d/C, 2 cycles | 6w | WHO | O1,2,6 |
| Wen, J. 2014 (37) | 15/15 | 23/7 | IIIB: 5, IIIC: 6, IV: 4/IIIB: 7, IIIC: 4, IV: 4 | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d, 14d/C, 4 cycles | Injection | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 4 cycles | 8w | RECIST, WHO |
O1,2,4,5 |
| Xiang, S.L. 2014 (38) | 33/33 | 28/38 | IIIB: 19, IV: 14/IIIB: 18, IV: 15 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d, d1–10, 28d/C, 2 cycles | Injection | PTX: 175 mg/m2, d1; DDP: 20 mg/m2, d1–5; 5-Fu: 600 mg/m2, d5–9; 28d/C, 2 cycles | 8w | WHO, WHO | O1,2,4,5 |
| Zhang, L. 2014 (39) | 32/32 | 35/29 | IIIA: 6, IIIB: 27, IV: 31 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50–80 ml/d, 21d/C, 2 cycles | Injection | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 2 cycles | 6w | WHO, WHO | O1,2,5 |
| Zhang, M.J. 2014 (40) | 48/48 | 54/42 | IIIB: 27, IV: 21/IIIB: 30, IV: 18 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d, 21d/C, 2 cycles | Injection | OXA: 130 mg/m2, d1; 5-Fu: 400 mg/m2, d1; 5-Fu: 2,600 mg/m2, d1–5; CF: 200 mg/m2, d1; 21d/C; 2 cycles | 6w | RECIST, Un | O1,4,5 |
| Zhang, Y.N. 2015 (41) | 46/38 | 49/35 | IV | Astragalus-based formulae: Astragalus, Codonopsis, Radix pseudostellariae, Atractylodis macrocephala, Poria cocos, Fructus lycii, Ligustrum lucidum ait, Semen cuscutae, Spatholobus suberctu, Paeonia rubra, Curcuma zedoary, Polyphylla, Hedyotis diffusa, Radix actinidiae, 400 ml/d, 21d/C, 3 cycles | Orally | CAP: 1,000 mg/m2, d1–14; OXA: 130 mg/m2, d1; 21d/C, 3 cycles | 9w | WHO | O1,2,4,6 |
| Duan, F. 2016 (42) | 46/46 | 51/41 | IIIB: 35, IV: 11/IIIB: 33, IV: 13 | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 50 ml/d, 21d/C, 2 cycles | Injection | PTX: 175 mg/m2, d1; DDP: 25 mg/m2, d1–5; 5-Fu: 600 mg/m2, d5–9; 28d/C, 2 cycles | 8w | WHO, WHO | O1,2,4,5 |
| Hu, Q. 2016 (43) | 21/21 | 18/24 | III, IV | Weining Granule: Astragalus, Hedyotis diffusa, Curcuma zedoary, Fructus lycii, Poria cocos, 400 ml/d, 28d/C, 3 cycles | Orally | OXA: 130 mg/m2, d1; S-1: BSA <1.25 m2, 80mg/d, 1.25–1.50 m2, 120 mg/d, >1.25 m2,160 mg/d; 42d/C, 2 cycles | 12w | WHO | O4,5,6 |
| Huang, P. 2016 (44) | 34/33 | 36/31 | IIIB-IV | Astragalus-based formulae: Astragalus, Radix pseudostellariae, Coix seed, Paeonia lactiflora, Agrimonia pilosa, Pinellia ternate, Citrus reticulata, Radix ophiopogonis, Curcuma zedoary, Hedyotis diffusa, Rice sprout, Malt, 200 ml/d, 21d/C, 2 cycles | Orally | OXA: 130 mg/m2, d1; S-1: 80 mg/m2, d1–14; 21d/C, 2 cycles | 6w | WHO, Un | O1,2,3,4,5,6 |
| Ma, M. 2016 (45) | 22/22 | 26/18 | III, IV | Astragalus-based formulae: Astragalus, Ground beeltle, Radix cynanchi panicullati, 400 ml/d, 21d/C, 2 cycles | Orally | OXA: 130 mg/m2, d1; S-1: 80 mg/m2, d1–14; 21d/C, 2 cycles | 6w | WHO, Un | O1,2,4,5 |
| Shao, K.F. 2016 (46) | 31/31 | 34/28 | III: 17, IV: 14/III: 15, IV: 16 | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Poria cocos, Coix seed, Semen lablab album, Amomum, Angelica Sinensis, Rhizoma cimicifugae, Dioscoreae opposita, Lotus seed, Bupleurum, Citrus reticulata, Radix platycodi, Glycyrrhiza, 400 ml/d, 4w | Orally | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 2 cycles | 4w | WHO | O5 |
| Hu, Q. 2017 (47) | 18/18 | 22/14 | IIIA: 5, IIIB: 6, IV: 7/IIIA: 6, IIIB: 8, IV: 4 | Kangai: Astragalus, Ginseng, Matrine, 50 ml/d, d1–14, 21d/C, 6 cycles | Injection | OXA: 130 mg/m2, d1; S-1: 120 mg/m2, d1–14; 21d/C, 6 cycles | >2y | RECIST, NCI | O1,2,3,5 |
| Pan, B.Y. 2018 (48) | 58/54 | 60/52 | IV | Bo-Er-Ning Capsule: Astragalus, Ligustrum lucidum ait, Pleione bulbocodioides, Purslane, Rhizoma paridis, Nightshade, Perilla fruit, Galli gigerii endothelium corneum, Rhubarb, Ornel, Bombyx batryticatus, 1.8g/d, d1–14; 21d/C, 3 cycles | Orally | Tegafur: 80–120 mg/d, d1–14; DDP: 40 mg, d1–3; 21d/C, 3 cycles | 3y | / | O3,4 |
| Xu, W. 2019 (49) | 66/66 | 79/53 | III: 29, IV: 37/III: 30, IV: 36 | Astragalus-based formulae: Astragalus, Codonopsis, Atractylodis macrocephala, Poria cocos, Pinellia ternate, Citrus reticulata, Coix seed, Dioscoreae opposita, Atractylodis macrocephala, Hedyotis diffusa, Glycyrrhiza, 400 ml/d, 8w | Orally | OXA: 85 mg/m2, d1; CF: 200 mg/m2, d1–2; 5-Fu: 400 mg/m2, d1–2; 5-Fu: 600 mg/m2, d1–2; 2w/C, 4 cycles | 8w | RECIST,Un | O1,2,5,6 |
| Yuan, D.D. 2019 (50) | 60/60 | 76/44 | III: 22, IV: 38/III: 24, IV: 36 | Shenqi Fuzheng: Astragalus, Codonopsis, 250 ml/d,14d/C, 4 cycles | Injection | DOC: 75 mg/m2, d1; DDP: 20 mg/m2, d1-5; 5-Fu: 750 mg/m2, d1–5; 28d/C, 4 cycles | 16w | WHO,Un | O1,2,5 |
| Zhu, Y.F. 2019 (51) | 30/30 | 48/12 | IV | Aidi: Astragalus, Ginseng, Cantharides, Eleutherococcus senticosus, 40 ml/d, 21d/C, 4 cycles | Injection | S-1: BSA<1.25 m2, 80 mg/d, >1.25 m2, 120 mg/d, d1–14; OXA: 130 mg/m2, d1; DOC: 75 mg/m2, d1; 21d/C, 4 cycles | 12w | RECIST, WHO | O1,2,4,5 |
| Hou, Y. 2020 (52) | 45/45 | 49/41 | IV | Astragalus-based formulae: Astragalus, Atractylodis macrocephala, Glycyrrhiza, Ginseng, Angelica sinensis, Rhizoma cimicifugae, Bupleurum, Citrus reticulata, 400 ml/d, 6w | Orally | CAP: 1,000 mg/m2, d1–14; OXA: 130 mg/m2, d1; 21d/C, 2 cycles | 6w–2y | RECIST,Un | O1,2,3,5 |
E/C, experimental group (Astragalus-containing TCM with PBC)/control group (PBC alone); PBC, platinum-based chemotherapy; M/F, male/female; 5-Fu, 5-fluorouracil; OXA, oxaliplatin; PTX, paclitaxel; DDP, cisplatin; CF, Calcium folinate; DOC, docetaxel; BSA, body surface area; CAP, capecitabine; WHO, World Health Organization guidelines for solid tumor responses; RECIST, Response Evaluation Criteria in Solid Tumors; Un, unclear; O, outcomes; O1, objective response rate (ORR); O2, disease control rate (DCR); O3, survival rate; O4, quality of life (QOL); O5, adverse drug reactions (ADRs); O6, peripheral blood lymphocyte levels.