Chinese Herbal Injections Combined with Platinum-Based Chemotherapy Improve Outcomes in Advanced Non-Small Cell Lung Cancer
A comprehensive meta-analysis of 140 randomized controlled trials has demonstrated that combining Chinese herbal injections (CHIs) with platinum-based chemotherapy significantly improves treatment outcomes and reduces adverse effects in patients with advanced non-small cell lung cancer (NSCLC).
Key Findings on Efficacy and Safety
The systematic review, published in Frontiers in Oncology, analyzed data from 12,053 patients across 140 high-quality randomized controlled trials. Researchers found that adding CHIs to standard platinum-based chemotherapy regimens resulted in:
- Significantly higher objective response rates (RR=1.35, 95% CI: 1.30-1.41)
- Improved disease control rates (RR=1.15, 95% CI: 1.13-1.18)
- Enhanced quality of life scores (RR=1.29, 95% CI: 1.24-1.33)
- Reduced incidence of chemotherapy-related adverse effects
"The efficacy of platinum-based chemotherapy in treating middle and advanced NSCLC is considerable; however, although it kills cancer cells, it also damages the human body, causing toxic side effects such as bone marrow suppression, nausea and vomiting, and liver and kidney toxicity," the researchers noted. "CHIs when combined with platinum-based chemotherapy exhibited a significant improvement in objective response rate, disease control rate, and quality of life."
Comparative Analysis of Different Chinese Herbal Injections
A complementary network meta-analysis of 85 studies specifically examining CHIs combined with docetaxel and cisplatin (DP) regimens provided further insights into the relative efficacy of different herbal injections:
- Astragalus Injection plus DP showed the highest response rate improvement (RR = 1.77)
- Brucea Javanica Oil Milk Injection plus DP was most effective for quality of life enhancement
- Shenfu Injection plus DP demonstrated superior effects on immune function markers (CD3+ and CD4+ levels)
- Kanglaite Injection plus DP was most effective in improving CD8+ levels
Mechanism of Action
The therapeutic benefits of CHIs appear to be multifaceted. Pharmacological studies indicate that these herbal extracts can:
- Inhibit tumor growth through various mechanisms including cell cycle arrest and apoptosis induction
- Modulate immune function by enhancing T-cell activity and macrophage phagocytosis
- Increase sensitivity to chemotherapy when used in combination
- Reduce toxic side effects of chemotherapeutic drugs
- Improve patients' quality of life
For example, Compound Kushen injection, derived from Sophora flavescens and Smilax glabra, has been shown to improve immune function and inhibit tumor cell proliferation. Aidi injection, containing extracts from cantharis, ginseng, and Astragalus membranaceus, demonstrates anti-tumor activity and immunomodulatory effects.
Reduction in Adverse Effects
The meta-analysis revealed significant reductions in chemotherapy-related side effects when CHIs were added to treatment regimens:
- Leukopenia (RR=0.69, 95% CI: 0.64-0.75)
- Anemia (RR=0.70, 95% CI: 0.62-0.79)
- Thrombocytopenia (RR=0.68, 95% CI: 0.62-0.75)
- Nausea and vomiting (RR=0.69, 95% CI: 0.63-0.76)
- Diarrhea (RR=0.59, 95% CI: 0.48-0.73)
- Constipation (RR=0.68, 95% CI: 0.54-0.86)
These reductions in adverse effects are particularly important for maintaining treatment adherence and quality of life in patients undergoing chemotherapy.
Clinical Implications
Based on the comprehensive analysis, researchers recommend Compound Kushen injection as the primary choice for clinical application due to its consistent positive effects on efficacy, quality of life, and reduction of side effects.
Several other CHIs, including Aidi injection, Kanglaite injection, Kangai injection, Shenmai injection, Shenqifuzheng injection, and Xiaoaiping injection, were recommended as secondary options due to their positive effects on efficacy and quality of life, despite showing less consistent benefits in reducing toxic side effects.
Dr. Wei Hou, one of the study authors, emphasized: "From the perspective of clinical practice, our results show that CHIs based on Chinese herbal extracts can improve the efficacy of platinum-based chemotherapy in NSCLC and reduce the incidence of adverse reactions."
Study Limitations and Future Directions
The researchers acknowledged several limitations in their analysis:
- All included studies were conducted in China, which may introduce regional bias
- Some CHIs had relatively few studies, potentially exaggerating their efficacy
- Publication bias was detected in the analysis
- Most studies did not mention allocation concealment and blinding
- The included studies had short follow-up periods, limiting assessment of long-term endpoints like overall survival
"In the future, high-quality RCTs with long-term endpoint results are needed to further verify the efficacy and safety of CHI in combination with platinum-based chemotherapy in advanced NSCLC treatment," the researchers concluded.
Despite these limitations, this comprehensive meta-analysis provides valuable evidence supporting the integration of traditional Chinese medicine with conventional chemotherapy for advanced NSCLC, potentially offering patients improved treatment outcomes with fewer side effects.
