Traditional Chinese medicinal herbs for induction of remission in advanced or late gastric cancer

Gastric cancer, one of the malignant tumours in the gastrointestinal tract and with high morbidity among cancers, can easily lead to death once it progresses to an advanced or late stage. There are few interventions which can postpone or stop the malignant course of the illness. However, some kinds of traditional Chinese medicinal herbs (TCMHs) have been used as an alternative therapeutic measure to treat many gastric cancer patients in China, and might be effective as an auxiliary therapy for this illness in its advanced or late stages. Our primary investigation showed there was no assured evidence concerning the effectiveness of TCMHs in improving the quality of life or rate of remission, alleviating the toxic and side effects caused by the chemotherapy, or reducing short-term mortality. Limited, weak evidence showed that four injections of the TCMHs Huachansu, Aidi, Fufangkushen, and Shenqifuzheng showed statistically significant differences for the improvement of leukopenia, and Huachansu, Aidi, and Fufangkushen for adverse events in the digestive system, but no significant differences in the rate of short-term remission. Most of the included studies were of low quality and valid comparisons were scarce, meaning that more trials are needed for meta-analysis to draw definite conclusions about their benefits.

Authors' conclusions: 

This review did not provide assured evidence concerning the effectiveness of TCMHs in improving quality of life or rate of remission, alleviating the toxicity or side effects of chemotherapy, or reducing short-term mortality. Limited, weak evidence showed that Huachansu, Aidi, Fufangkushen, and Shenqifuzheng improved leukopenia when used together with chemotherapy; and Huachansu, Aidi, and Fufangkushen were of benefit for adverse events in the digestive system caused by chemotherapy. These TCMHs did not improve the rate of short-term remissions. Large, well designed clinical trials are required urgently before any definite conclusions can be drawn about the value of TCMHs for advanced or late stage gastric cancer.

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Background: 

Gastric cancer is difficult to cure once it progresses to an advanced or late stage. Although some chemotherapies or bio-therapies have made progress in the remission of this disease, the mortality from gastric cancer remains high. A variety of Chinese medicinal herbs have been used to treat gastric cancer.

Objectives: 

To assess the effectiveness of Chinese medicinal herbs in the short-term remission of advanced or late gastric cancer.

Search strategy: 

We searched the The Cochrane Library, MEDLINE, EMBASE, AHMED (Allied and Complementary Medicine Database) and CBM (Chinese Biomedical Database) from the first year of the databases to June 2011. We handsearched a number of journals.

Selection criteria: 

All randomised clinical trials of Chinese herbs for advanced or late gastric cancer were included.

Data collection and analysis: 

Two authors independently extracted the data, which were analysed using RevMan 5.1 software (RevMan 2011). For dichotomous data, we estimated the relative risk. For continuous data, we calculated the weighted mean difference.

Main results: 

Eighty-five trials with 6857 advanced or late gastric cancer patients were identified for inclusion, most were of low quality and used traditional Chinese medicinal herbs (TCMHs) plus chemotherapy compared with the same chemotherapy alone (65 trials). Apart from 23 trials of four different kinds of TCMHs, we could not pool the results because no more than two used the same intervention or outcomes.

TCMHs with or without chemotherapy, in 57 trials, showed statistically significant differences for the improvement of mortality in nine trials, quality of life in 16 trials, rate of remission in 11 trials, and leukopenia in five trials. The pooled results from the four injected TCMHs, Huachansu, Aidi, Fufangkushen, and Shenqifuzheng showed statistically significant differences for the improvement of leukopenia, but no significant difference in the rate of short-term remission.

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