Whether traditional Chinese medicine injection can reduce adverse events in patients with cancer? A meta-analysis of randomized controlled trials.

ETHNOPHARMACOLOGICAL RELEVANCE

Adverse events of anticancer treatment were common and debilitating in cancer patients. Traditional Chinese medicine injection (TCMI) plays an important role in the comprehensive treatment of cancer in China.

AIM OF THE REVIEW

To explore whether TCMI can reduce adverse events of anticancer treatment in patients with cancer.

MATERIALS AND METHODS

Ten databases (i.e., Embase, Web of Science, PubMed, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, Wangfang Database and VIP) were searched up to July 2, 2024. RCT was included if it assessed TCMI in cancer patients and reported any type of adverse events. Data were extracted from eligible studies, and risk of bias was assessed using the RoB2 tool. Certainty of evidence was evaluated by the GRADE tool. Meta analysis was conducted by using random effects model. Subgroup and sensitivity analyses were performed for primary outcomes. The publication bias was evaluated for outcomes reported by more than 10 trials using funnel plots and Egger's test.

RESULTS

A total of 76 eligible RCTs involving 9862 patients with cancer and 45 type of adverse events were included. Meta-analysis revealed that compared with anticancer therapy alone, combination treatment with TCMI had lower risk for adverse events in bone marrow suppression (RR 0.60; 95 % CI,0.51, 0.70) and gastrointestinal issues (RR 0.69; 95 % CI, 0.63, 0.76). Also, TCMI was associated with decreased risk of leukopenia (RR 0.67; 95 % CI, 0.61, 0.74), thrombocytopenia (RR 0.66; 95 % CI, 0.57, 0.77), hemoglobin reduction (RR 0.76; 95 % CI, 0.68, 0.86), neutropenia (RR 0.74; 95 % CI,0.59, 0.93), anemia (RR 0.57; 95 % CI, 0.48, 0.68), liver adverse events (RR 0.63; 95 % CI, 0.54, 0.74), renal adverse events (RR 0.55; 95 % CI, 0.43, 0.70), neurotoxicity (RR 0.70; 95 % CI, 0.61, 0.81), cardiovascular toxicity (RR 0.42; 95 % CI, 0.23, 0.77), radiation-induced injuries (RR 0.43; 95 % CI, 0.34, 0.54]), oral mucositis (RR 0.46; 95 % CI, 0.36, 0.58), fatigue (RR 0.66; 95 % CI, 0.48, 0.90), fever (RR 0.52; 95 % CI, 0.32, 0.85), infection (RR 0.48; 95 % CI, 0.32, 0.72) and chemotherapy toxicity (RR 0.95; 95 % CI, 0.36, 0.86). GRADE assessment indicated high certainty for evidence in bone marrow suppression, hemoglobin reduction, liver adverse events, renal adverse events and oral mucositis.

CONCLUSION

TCMI can reduce adverse events of anticancer treatment and serve as an adjuvant therapy. It is necessary to strengthen the mechanism research of TCMI and carry out more large-scale, multi-center and well-designed clinical studies to evaluate the synergistic effects of TCMI in the future.